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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Plasma Levels of Soluble Tumor Necrosis Factor Receptor Type I During the Acute Phase Following Complicated Myocardial Infarction Predicts Survival in High-Risk Patients

Thor Ueland, PhD^_*,,_*, John Kjekshus, MD, PhD, Stig S. Frøland, MD, PhD^,, Torbjørn Omland, MD, PhD^||, Iain B. Squire, MD^#, Lars Gullestad, MD, PhD, Kenneth Dickstein, MD, PhD^¶ and Pål Aukrust, MD, PhD^,

^_* Section of Endocrinology, National University Hospital, Oslo, Norway
Department of Cardiology, National University Hospital, Oslo, Norway
Section of Clinical Immunology and Infectious Diseases, National University Hospital, Oslo, Norway
Research Institute for Internal Medicine, National University Hospital, Oslo, Norway
^|| Department of Medicine, Akershus University Hospital, Nordbyhagen, Norway
^¶ Cardiology Division, Stavanger University Hospital, Stavanger, Norway
^# Department of Medicine and Therapeutics, University of Leicester, Leicester, United Kingdom

Manuscript received March 18, 2005; revised manuscript received June 15, 2005, accepted August 1, 2005.

^_* Reprint requests and correspondence: Dr. Thor Ueland, Section of Endocrinology, Medical Department, National University Hospital, N-0027 Oslo, Norway (Email: thor.ueland{at}medisin.uio.no).

OBJECTIVES: We sought to determine the relationship between circulating cytokine levels and clinical outcomes in patients with heart failure (HF) following acute myocardial infarction (AMI).

BACKGROUND: Persistent inflammation plays a role in the development of HF, and various inflammatory cytokines predict cardiovascular events in acute coronary syndromes.

METHODS: We measured plasma levels of interleukin (IL)-6, monocyte chemotractant protein 1, IL-10, and soluble tumor necrosis factor receptor type 1 (sTNFR1) during longitudinal testing over a period of two years in 234 patients with HF following AMI recruited for participation in the OPTIMAAL trial, focusing on the possible prognostic value of circulating cytokine levels in these patients.

RESULTS: Measurement of sTNFR1 at baseline predicted all-cause mortality and cardiovascular death in patients with post-MI HF after adjustment for other biomarkers that have been shown to give prognostic information in HF patients, such as N-terminal B-type natriuretic peptide.

CONCLUSIONS: Assessment of sTNFR1 levels might provide important prognostic information in patients who develop HF during the acute phase following AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   HF = heart failure   hsCRP = high-sensitivity C-reactive protein   IL = interleukin   LV = left ventricular   MCP = monocyte chemoattractant peptide   N-BNP = N-terminal B-type natriuretic peptide   sTNFR1 = soluble tumor necrosis factor receptor type 1

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