TY - JOUR
T1 - A proinflammatory monocyte response is associated with myocardial injury and impaired functional outcome in patients with ST-segment elevation myocardial infarction
T2 - Monocytes and myocardial infarction
AU - van der Laan, Anja M.
AU - Hirsch, Alexander
AU - Robbers, Lourens F. H. J.
AU - Nijveldt, Robin
AU - Lommerse, Ingrid
AU - Delewi, Ronak
AU - van der Vleuten, Pieter A.
AU - Biemond, Bart J.
AU - Zwaginga, Jaap Jan
AU - van der Giessen, Wim J.
AU - Zijlstra, Felix
AU - van Rossum, Albert C.
AU - Voermans, Carlijn
AU - van der Schoot, C. Ellen
AU - Piek, Jan J.
AU - HEBE Investigators
PY - 2012/1
Y1 - 2012/1
N2 - Background In patients with ST-segment elevation myocardial infarction (STEMI), the importance of a well-balanced inflammatory reaction has been recognized for years. Monocytes play essential roles in regulating inflammation. Hence, we investigated the association between inflammatory characteristics of monocytes and myocardial injury and functional outcome in patients with STEMI.Methods Using flow cytometry, the levels of classical (CD14(++)CD62L(+)) and nonclassical (CD14(+)CD62L(-)) monocytes were analyzed in peripheral blood in 58 patients with STEMI at a median of 5 days (4-6 days) after primary percutaneous coronary intervention. In addition, the monocytic expression of several surface molecules and formation of monocyte-platelet complexes were measured. All patients underwent cardiovascular magnetic resonance imaging at baseline and 4-month follow-up.Results At baseline, patients with high levels of classical monocytes had impaired left ventricular (LV) ejection fraction (P = .002), larger infarct size (P = .001), and, often, presence of microvascular obstruction (P = .003). At follow-up, high levels of classical monocytes were negatively associated with the regional systolic LV function independent of the transmural extent of infarction. In contrast, positive associations for the levels of nonclassical monocytes were observed. Finally, up-regulation of macrophage 1 by blood monocytes and increased formation of monocyte-platelet complexes were associated with enhanced myocardial injury at baseline and impaired LV function at follow-up.Conclusions This study shows an association between a proinflammatory monocyte response, characterized by high levels of classical monocytes, and severe myocardial injury and poor functional outcome after STEMI. Future studies are required to investigate the biologic nature of this association and therapeutic implications. (Am Heart J 2012;163:57-65.e2.)
AB - Background In patients with ST-segment elevation myocardial infarction (STEMI), the importance of a well-balanced inflammatory reaction has been recognized for years. Monocytes play essential roles in regulating inflammation. Hence, we investigated the association between inflammatory characteristics of monocytes and myocardial injury and functional outcome in patients with STEMI.Methods Using flow cytometry, the levels of classical (CD14(++)CD62L(+)) and nonclassical (CD14(+)CD62L(-)) monocytes were analyzed in peripheral blood in 58 patients with STEMI at a median of 5 days (4-6 days) after primary percutaneous coronary intervention. In addition, the monocytic expression of several surface molecules and formation of monocyte-platelet complexes were measured. All patients underwent cardiovascular magnetic resonance imaging at baseline and 4-month follow-up.Results At baseline, patients with high levels of classical monocytes had impaired left ventricular (LV) ejection fraction (P = .002), larger infarct size (P = .001), and, often, presence of microvascular obstruction (P = .003). At follow-up, high levels of classical monocytes were negatively associated with the regional systolic LV function independent of the transmural extent of infarction. In contrast, positive associations for the levels of nonclassical monocytes were observed. Finally, up-regulation of macrophage 1 by blood monocytes and increased formation of monocyte-platelet complexes were associated with enhanced myocardial injury at baseline and impaired LV function at follow-up.Conclusions This study shows an association between a proinflammatory monocyte response, characterized by high levels of classical monocytes, and severe myocardial injury and poor functional outcome after STEMI. Future studies are required to investigate the biologic nature of this association and therapeutic implications. (Am Heart J 2012;163:57-65.e2.)
KW - INTRACORONARY INFUSION
KW - CORONARY INTERVENTION
KW - BONE-MARROW
KW - HEBE TRIAL
KW - ADHESION
KW - CELLS
KW - HETEROGENEITY
KW - CD11B/CD18
KW - ACTIVATION
KW - INTEGRIN
U2 - 10.1016/j.ahj.2011.09.002
DO - 10.1016/j.ahj.2011.09.002
M3 - Article
SN - 0002-8703
VL - 163
SP - 57
EP - 65
JO - American Heart Journal
JF - American Heart Journal
IS - 1
ER -