Inflammatory patterns in Takotsubo cardiomyopathy and acute coronary syndrome: A propensity score matched analysis
Francesco Santoro1, Maria Domenica Costantino2, Francesca Guastafierro3
1Department of Medical and Surgical Science, University of Foggia, Foggia, Italy; Department of Cardiology, Asklepios Klinik - St Georg, Hamburg, Germany.
Insights
Takotsubo cardiomyopathy (TTC) shows higher anti-inflammatory cytokine levels during acute phases, unlike acute coronary syndrome (ACS), which has elevated IL-6. These distinct inflammatory profiles aid in differentiating TTC and ACS.
Area of Science:
- Cardiology
- Immunology
- Biochemistry
Background:
- Systemic inflammation is present in both Takotsubo cardiomyopathy (TTC) and acute coronary syndrome (ACS).
- Understanding the differences in inflammatory responses between these conditions is crucial for diagnosis and treatment.
- Cytokine profiles offer insights into the underlying pathophysiological mechanisms.
Purpose of the Study:
- To compare circulating cytokine levels between patients with TTC and ACS.
- To investigate the inflammatory patterns during the acute and subacute phases of TTC and ACS.
- To identify potential biomarkers for differentiating these cardiac conditions.
Main Methods:
- A cohort of 136 patients was analyzed, with 32 TTC patients propensity score-matched to 32 ACS patients.
- Circulating levels of various interleukins (ILs), interferons (IFNs), and growth factors were measured at admission (t0) and after 120 hours (t1).
- Key measured cytokines included IL-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, IFN-γ, MCP1, EGF, VEGF, and TNFα.
Main Results:
- At admission (t0), TTC patients exhibited higher levels of IL-2, IL-4, IL-10, TNF-α, IFN-γ, and EGF compared to ACS patients.
- Conversely, IL-6 levels were significantly higher in ACS patients at both t0 and t1.
- In the subacute phase (t1), IL-2 and EGF remained elevated in TTC patients, while IL-6 persisted higher in ACS patients.
Conclusions:
- Distinct inflammatory patterns characterize the acute and subacute phases of TTC and ACS.
- TTC is associated with increased levels of anti-inflammatory interleukins during the acute phase.
- ACS is characterized by higher IL-6 levels throughout the acute and subacute phases, suggesting different inflammatory pathways.
Background And Aims:
Systemic inflammatory activation can be observed in both Takotsubo cardiomyopathy (TTC) and acute coronary syndrome (ACS). The aim of this study was therefore to compare circulating cytokine levels during the acute and subacute phase of TTC and ACS.
Methods:
One hundred thirty-six consecutive patients were enrolled in the study; after a propensity score matching, 32 TTC patients were compared with 32 subjects with ACS. Clinical baseline features and circulating levels of interleukin(IL)-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, IFN-γ, MCP1, EGF, VEGF, TNFα were obtained at admission (t0) and after 120 h (t1).
Results:
At t0, several circulating IL levels were higher in subjects with TTC (IL-2 2 vs. 0.5 pg/ml, IL-4 1.5 vs. 0.82 pg/ml, IL-10 3.34 vs. 1.62 pg/ml, TNF-α 5 vs. 2.3 pg/ml, IFN-γ 0.92 vs. 0.32 pg/ml, EGF 84.8 vs. 10.7 pg/ml, p < 0.05 in all cases), while IL-6 levels were higher in patients with ACS (25.4 vs. 12.4 pg/ml p = 0.03). At t1, IL-2 and EGF levels were still higher in patients with TTC vs. those with ACS (IL-2 4.6 vs. 0.72 pg/ml, p = 0.01; EGF 36.3 vs. 18.5 pg/ml, p = 0.03), while IL-6 serum levels were higher in ACS patients (19.6 vs. 7.35 pg/ml, p = 0.02).
Conclusions:
Different inflammatory patterns can be observed during the acute and subacute phase of TTC when compared to ACS. Increased levels of anti-inflammatory interleukins can be found during the acute phase of TTC while ACS is featured by higher levels of IL-6 during the acute and sub-acute phase.
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