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Updated: Aug 31, 2025
In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Circulating Monocyte Chemoattractant Protein-1 in Patients with Cardiogenic Shock Complicating Acute Myocardial
Wenke Cheng1,2, Georg Fuernau3, Steffen Desch1
1Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany.
Insights
Mild therapeutic hypothermia (MTH) did not affect monocyte chemoattractant protein-1 (MCP-1) levels during cooling in acute myocardial infarction patients with cardiogenic shock. MCP-1 levels increased after rewarming, suggesting a delayed inflammatory response.
Area of Science:
- Cardiology
- Immunology
- Critical Care Medicine
Background:
- Monocyte chemoattractant protein-1 (MCP-1) is a key inflammatory marker in cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
- The impact of mild therapeutic hypothermia (MTH) on MCP-1 levels in this patient population remains unclear.
- Understanding these inflammatory dynamics is crucial for predicting clinical outcomes in CS post-AMI.
Purpose of the Study:
- To investigate the effect of MTH on MCP-1 levels in patients with CS complicating AMI.
- To assess the association between MCP-1 levels and 30-day all-cause mortality in this cohort.
Main Methods:
- A randomized trial (SHOCK-COOL) enrolled 40 patients with CS complicating AMI, assigning them to MTH (33 °C for 24 hours) or normothermia.
- Blood samples were collected on days 1, 2, and 3 post-admission for MCP-1 level analysis.
- Statistical analyses included assessing differences between and within groups, and Cox proportional hazards models for mortality risk.
Main Results:
- A significant interaction was observed in MCP-1 levels over time between the MTH and normothermia groups (P=0.013).
- MCP-1 levels significantly increased from day 1 to day 3 in the MTH group and were higher on day 3 compared to the normothermia group (P=0.011).
- Higher MCP-1 levels at hospitalization showed a trend towards decreased 30-day all-cause mortality (HR=2.61, P=0.051).
Conclusions:
- The cooling phase of MTH did not significantly alter MCP-1 levels in patients with CS complicating AMI.
- MCP-1 levels significantly increased after the rewarming phase of MTH.
- Elevated MCP-1 levels at admission may indicate a potentially better prognosis regarding 30-day mortality.
Background:
There is evidence that monocyte chemoattractant protein-1 (MCP-1) levels reflect the intensity of the inflammatory response in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and have a predictive value for clinical outcomes. However, little is known about the effect of mild therapeutic hypothermia (MTH) on the inflammatory response in patients with CS complicating AMI. Therefore, we conducted a biomarker study to investigate the effect of MTH on MCP-1 levels in patients with CS complicating AMI.
Methods:
In the randomized mild hypothermia in cardiogenic shock (SHOCK-COOL) trial, 40 patients with CS complicating AMI were enrolled and assigned to MTH (33 °C) for 24 h or normothermia at a 1:1 ratio. Blood samples were collected at predefined time points at the day of admission/day 1, day 2 and day 3. Differences in MCP-1 levels between and within the MTH and normothermia groups were assessed. Additionally, the association of MCP-1 levels with the risk of all-cause mortality at 30 days was analyzed. Missing data were accounted for by multiple imputation as sensitivity analyses.
Results:
There were differences in MCP-1 levels over time between patients in MTH and normothermia groups (P for interaction = 0.013). MCP-1 levels on day 3 were higher than on day 1 in the MTH group (day 1 vs day 3: 21.2 [interquartile range, 0.25-79.9] vs. 125.7 [interquartile range, 87.3-165.4] pg/mL; p = 0.006) and higher than in the normothermia group at day 3 (MTH 125.7 [interquartile range, 87.3-165.4] vs. normothermia 12.3 [interquartile range, 0-63.9] pg/mL; p = 0.011). Irrespective of therapy, patients with higher levels of MCP-1 at hospitalization tended to have a decreased risk of all-cause mortality at 30 days (HR, 2.61; 95% CI 0.997-6.83; p = 0.051).
Conclusions:
The cooling phase of MTH had no significant effect on MCP-1 levels in patients with CS complicating AMI compared to normothermic control, whereas MCP-1 levels significantly increased after rewarming.
Trial Registration:
NCT01890317.
