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TNF-α is a Novel Biomarker for Predicting Plaque Rupture in Patients with ST-Segment Elevation Myocardial Infarction
Xing Luo1,2, Chen Zhao1,2, Shengfang Wang1,2
1Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.
Insights
Tumor necrosis factor-alpha (TNF-α) mRNA levels in monocytes can help distinguish between plaque rupture and plaque erosion in ST-segment elevation myocardial infarction patients. Elevated TNF-α shows potential as a noninvasive biomarker for predicting plaque rupture and improving patient management.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Biomarker Discovery
Background:
- Plaque rupture (PR) and plaque erosion (PE) are distinct pathological mechanisms in cardiovascular disease, associated with different risks and outcomes.
- Current diagnostic methods lack noninvasive biomarkers to differentiate between PR and PE in patients with ST-segment elevation myocardial infarction (STEMI).
- Understanding the inflammatory differences between PR and PE is crucial for targeted therapeutic strategies.
Purpose of the Study:
- To investigate the potential of monocyte mRNA expression of inflammatory cytokines (IL-4, IL-10, IL-1β, TNF-α) as noninvasive biomarkers to distinguish between PR and PE in STEMI patients.
- To evaluate the association of these cytokine mRNA levels with the type of atherosclerotic plaque (rupture vs. erosion).
Main Methods:
- A prospective analysis of 382 STEMI patients (262 with PR, 120 with PE) and 83 stable angina controls.
- Peripheral blood monocyte mRNA expression of IL-4, IL-10, IL-1β, and TNF-α was measured pre-percutaneous coronary intervention.
- Statistical analyses, including receiver-operating characteristic (ROC) curve analysis and multivariable logistic regression, were performed.
Main Results:
- STEMI patients exhibited higher mRNA expression of IL-4, IL-10, IL-1β, and TNF-α compared to controls.
- mRNA levels of IL-4, IL-1β, and TNF-α were significantly higher in PR patients than in PE patients; IL-10 showed no significant difference.
- TNF-α demonstrated high diagnostic accuracy (AUC 0.895) for discriminating PR from PE, with a sensitivity of 70.61% and specificity of 93.33% at a specific cutoff. TNF-α independently predicted PR.
Conclusions:
- Patients with plaque rupture exhibit a heightened inflammatory response in peripheral blood mononuclear cells compared to those with plaque erosion.
- Tumor necrosis factor-alpha (TNF-α) shows significant potential as a noninvasive biomarker for identifying plaque rupture in STEMI patients.
- The use of TNF-α could aid in risk stratification and guide clinical management strategies for STEMI patients with different plaque morphologies.
Background And Aims:
Patients with plaque rupture (PR) present with different cardiovascular risks, clinical strategies, and outcomes from those with plaque erosion (PE). However, there are lack of noninvasive biomarkers to distinguish PE from PR.
Methods:
A prospective analysis of 382 patients with ST-segment elevation myocardial infarction (STEMI) was conducted. Of these patients, 262 and 120 presented with PR and PE, respectively. An additional 83 patients diagnosed with stable angina pectoris were enrolled as control group. Peripheral blood monocytes were collected pre-percutaneous coronary intervention and used to evaluate the mRNA expression of IL-4, IL-10, IL-1β, and TNF-α in all patients.
Results:
STEMI patients had higher IL-4, IL-10, IL-1β, and TNF-α expression than the control patients. The mRNA levels of IL-4, IL-1β, and TNF-α were significantly higher in PR patients than PE; however, no significant difference was observed in IL-10 between PE and PR. The areas under the receiver-operating characteristic curves for IL-4, IL-1β, and TNF-α for PR versus PE were 0.685, 0.747, and 0.895, respectively. At the cut-off value of 2.52, TNF-α demonstrated a sensitivity of 70.61% and specificity of 93.33% for discriminating PR from PE patients. When added to the model of established clinical risk factors, TNF-α significantly improved the predictive accuracy of PR. Multivariable logistic regression analysis indicated that TNF-α mRNA level was independently associated with PR (odds ratio, 3.09; 95% confidence interval, 2.29-4.16; p < 0.001).
Conclusion:
The inflammatory response of peripheral blood mononuclear cells in patients with PR was higher than that in patients with PE. TNF-α may be a potential biomarker for predicting PR that could facilitate risk stratification and management in STEMI patients.
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