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Granulocyte elastase in acute myocardial infarction
P Lechleitner1, J Mair, N Genser
1Department of Internal Medicine, University of Innsbruck, Austria.
Insights
Plasma concentrations of polymorphonuclear granulocytes elastase (PMN elastase) indicate neutrophil activation in acute myocardial infarction. Elevated PMN elastase levels may help identify patients with complications, independent of thrombolytic therapy.
Area of Science:
- Cardiology
- Biochemistry
- Immunology
Background:
- Neutrophil activation is implicated in acute myocardial infarction (AMI).
- Polymorphonuclear granulocytes elastase (PMN elastase) in complex with alpha-1 proteinase inhibitor serves as a marker for neutrophil activation.
- Assessing PMN elastase may offer insights into AMI pathophysiology and complications.
Purpose of the Study:
- To investigate plasma concentrations of PMN elastase in patients with AMI.
- To evaluate the relationship between PMN elastase levels and myocardial injury markers.
- To determine if thrombolytic therapy influences PMN elastase levels and if PMN elastase can predict AMI complications.
Main Methods:
- Serial peripheral venous blood samples were collected from 39 AMI patients.
- Measurements included PMN elastase, creatine kinase, and cardiac troponin T.
- Patients were categorized based on thrombolytic therapy (streptokinase, urokinase, recombinant tissue plasminogen activator) or conventional treatment, and presence of complications.
Main Results:
- All AMI patients exhibited elevated PMN elastase levels.
- Peak and cumulative PMN elastase concentrations did not strongly correlate with myocardial injury markers.
- PMN elastase levels increased within 6 hours of thrombolytic therapy initiation, unlike in conventionally treated patients.
- Significantly higher PMN elastase concentrations were observed in AMI patients with complications (cardiac arrest, rupture, shock) compared to uncomplicated cases.
- Changes in PMN elastase levels paralleled or preceded clinical presentation in complicated cases.
Conclusions:
- Thrombolytic treatment does not appear to significantly alter systemic neutrophil activation in AMI.
- Plasma PMN elastase is a potential biomarker for monitoring and identifying complications in acute myocardial infarction.
- Further research could explore the prognostic value of PMN elastase in AMI management.
Abstract:
Plasma concentrations of polymorphonuclear granulocytes elastase (PMN elastase) in complex with alpha-1 proteinase inhibitor are a marker of neutrophil activation. The latter complex, creatine kinase and cardiac troponin T, were measured in peripheral venous blood samples serially drawn in 39 patients with acute myocardial infarction. Of the total, 29 received intravenous thrombolytic therapy either with streptokinase (n = 15), urokinase (n = 7) or recombinant tissue type plasminogen activator (n = 7). Creatine kinase activities and cardiac troponin T concentrations were used as markers of myocardial tissue injury. In all patients with acute myocardial infarction, PMN elastase was elevated (median 80 micrograms/l, interquartile range 71 to 100 micrograms/l). Peak and cumulative (area under curve) concentrations of PMN elastase did not correlate closely with determinants of myocardial injury (r < 0.2, n.s.). PMN elastase increased during the first 6 h after starting thrombolytic therapy, whereas it decreased in conventionally treated patients and 12 h later increased. Maximum concentrations of PMN elastase, however, were not significantly higher in patients with thrombolytic therapy than in those without. In acute myocardial infarction patients with complications such as cardiac arrest with subsequent resuscitation (n = 5), cardiac rupture (n = 1) or cardiogenic shock (n = 2), PMN elastase plasma concentrations were significantly higher (p = 0.04) than in uncomplicated infarctions. In the complicated patients, changes in elastase concentrations paralleled or even preceded changes in the clinical presentation. Therefore, thrombolytic treatment seems not to significantly influence the amount of systemic neutrophil activation, but plasma PMN elastase could be a useful marker to monitor and identify complications in acute myocardial infarction.