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Published on: February 16, 2016
TNF-α, myocardial perfusion and function in patients with ST-segment elevation myocardial infarction and primary
Eva S Kehmeier1, Wolfgang Lepper, Martina Kropp
1Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Aachen, 52074 Aachen, Germany.
Insights
Early elevation of tumor necrosis factor-alpha (TNF-α) after ST-segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) correlates with myocardial damage. Higher TNF-α levels predict larger infarct size, highlighting its clinical significance.
Area of Science:
- Cardiology
- Immunology
- Biomarkers
Background:
- ST-segment elevation myocardial infarction (STEMI) triggers inflammatory responses.
- Tumor necrosis factor-alpha (TNF-α) is a key inflammatory cytokine implicated in myocardial injury.
- Understanding the temporal dynamics of TNF-α post-STEMI and its relation to cardiac function is crucial.
Purpose of the Study:
- To investigate the time course of serum TNF-α levels following successful primary percutaneous coronary intervention (PCI) in STEMI patients.
- To assess the correlation between early TNF-α levels and myocardial perfusion, contractile function, and infarct size.
- To determine if early TNF-α predicts long-term infarct size.
Main Methods:
- Serum levels of TNF-α, IL-6, and CRP were measured in 42 STEMI patients before and at 1 and 6 days after primary PCI.
- Myocardial perfusion and contractile function were assessed using echocardiography (ceEcho, 2DE, RT-3DE).
- Infarct size was quantified by LGE-CMR in 18 patients on day six.
Main Results:
- Serum TNF-α levels increased continuously from symptom onset, peaking by day six, while IL-6 and CRP peaked on day one.
- Early post-PCI TNF-α levels significantly correlated with perfusion defects, wall motion abnormalities, and infarct size.
- Serum TNF-α on day one post-PCI was a significant predictor of infarct size on day six (adjusted R²=0.638).
Conclusions:
- Early elevation of TNF-α after STEMI and primary PCI is clinically significant.
- TNF-α serves as an early biomarker for myocardial injury severity and predicts infarct size.
- These findings underscore the role of TNF-α in STEMI pathophysiology and outcomes.
Aims:
To characterize the time course of tumor necrosis factor-α (TNF-α) serum levels along with myocardial perfusion and contractile function in patients with ST-segment elevation myocardial infarction (STEMI) and successful primary percutaneous coronary intervention (PCI).
Methods:
Serum levels of TNF-α, interleukin 6 (IL-6), and C-reactive protein (CRP) were measured in 42 patients with STEMI before, one and 6 days after successful PCI. Myocardial perfusion was assessed by contrast-enhanced echocardiography (ceEcho), contractile function by unenhanced two-dimensional (2DE) and real-time three-dimensional echocardiography. In a subset of 18 patients, infarct size was quantified by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) on day six.
Results:
TNF-α serum levels were in the upper normal range within the first 12 h from symptom onset and increased continuously until day six, while IL-6 and CRP increased subsequently with a peak on day one after STEMI. Serum TNF-α on day one after PCI correlated with perfusion defects, wall motion abnormalities, and infarct size (ceEcho: r = 0.52, p = 0.005; 2DE: r = 0.56, p = 0.002; LGE-CMR: r = 0.83-0.86; p < 0.0001). Using multiple regression linear analysis, infarct size on day six was predicted by serum TNF-α 1 day after PCI (p = 0.006, adjusted R (2) 0.638).
Conclusion:
Our data reflect the clinical significance of early TNF-α elevation in patients with STEMI and primary PCI (Controlled Clinical Trials number, NCT00529607).
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