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Circulating B-cell activating factor in acute coronary syndromes - association with adverse outcomes and progression
Thor Ueland1, Geir Øystein Andersen2, Sharanga Varathalingam3
1Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
Insights
Plasma B-cell activating factor (BAFF) levels are linked to adverse outcomes in myocardial infarction (MI) patients. Higher BAFF levels correlate with increased mortality and major adverse cardiac events (MACE) in both NSTEMI and STEMI.
Area of Science:
- Cardiology
- Immunology
- Biochemistry
Background:
- B cells and B-cell activating factor (BAFF) play a role in myocardial infarction (MI) pathogenesis.
- Limited data exists on BAFF regulation and its specific role in MI development and outcomes.
Purpose of the Study:
- To investigate the association between plasma BAFF levels and clinical outcomes in patients with non-ST-elevation MI (NSTEMI) and ST-elevation MI (STEMI).
Main Methods:
- Plasma BAFF levels were measured using enzyme immunoassay in 732 NSTEMI and 261 STEMI patients at hospital admission.
- In STEMI patients, BAFF levels were also assessed during follow-up.
- Outcomes included mortality, major adverse cardiac events (MACE), infarct size, and left ventricular ejection fraction (LVEF) assessed by cardiac magnetic resonance imaging (CMR).
Main Results:
- In NSTEMI, admission BAFF levels correlated with mortality and MACE, with MACE remaining significant after adjusting for inflammatory markers and renal function.
- In STEMI, BAFF levels peaked at 4 months post-MI and were associated with all-cause mortality, even after adjustment for clinical risk scores and biomarkers.
- STEMI patients with larger infarcts and reduced LVEF (<50%) at 4 months exhibited higher BAFF levels.
Conclusions:
- The study supports a significant role for BAFF in the development of MI.
- BAFF may also be implicated in post-MI cardiac remodeling processes.
Background:
B cells and B-cell activating factor (BAFF) are involved in the development of myocardial infarction (MI), but data on the regulation and role of BAFF in MI are scarce.
Objectives:
To examine possible associations between plasma BAFF levels and outcomes in non-ST-elevation MI (NSTEMI) and STEMI.
Methods:
We analyzed plasma BAFF at hospital admission by enzyme immunoassay in 732 patients with NSTEM and 261 patients with STEMI, and in STEMI also during follow-up. Plasma levels were related to pre-defined clinical outcomes (mortality and a composite of major adverse cardiac events [MACE]) in both groups and included infarct size and left ventricular ejection fraction (LVEF) evaluated by cardiac magnetic resonance imaging (CMR) in the STEMI group.
Results:
Our major findings were: (i) BAFF levels at hospital admission were associated with adverse clinical outcome (i.e., mortality and MACE) in NSTEMI, also after adjustment for demographic variables, but only MACE was significant after adjustment for CRP, TnT and eGFR. (ii) In STEMI, BAFF levels increased from baseline and were highest at 4-months in patients who died during long term follow-up. Levels at 4 months were associated with all-cause death in adjusted analysis including CRP, TnT and the Thrombolysis in Myocardial Infarction (TIMI) risk score. (iii) STEMI patients with the largest infarct size and those with LVEF <50 % at 4 months, had higher levels of BAFF at 4 months, compared with the other STEMI patients.
Conclusion:
Our study supports a role for BAFF in the development of MI, potentially also in post-MI remodeling.
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