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EXPEDITED REVIEW

Serum Tenascin-C Might Be a Novel Predictor of Left Ventricular Remodeling and Prognosis After Acute Myocardial Infarction

Akira Sato, MD^_*, Kazutaka Aonuma, MD, Kyoko Imanaka-Yoshida, MD, Toshimichi Yoshida, MD^,_*, Mitsuaki Isobe, MD, Daisuke Kawase^||, Noriaki Kinoshita, PhD^||, Yoshio Yazaki, MD^¶ and Michiaki Hiroe, MD^#

^_* Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
Department of Cardiology, University of Tsukuba Graduate School of Comprehensive Human Science, Tsukuba, Japan
Departments of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Japan
Department of Cardiovascular Medicine, Tokyo Medical and Dental Postgraduate School of Medicine, Tokyo, Japan
^|| IBL Co., Gunma, Japan
^¶ National Hospital Organization, Tokyo, Japan
^# Department of Nephrology and Cardiology, International Medical Center of Japan, Tokyo, Japan

Manuscript received January 23, 2006; revised manuscript received March 7, 2006, accepted March 15, 2006.

^_* Reprint requests and correspondence: Dr. Kyoko Imanaka-Yoshida, Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan (Email: imanaka{at}doc.medic.mie-u.ac.jp).

OBJECTIVES: We investigated clinical implications of serum tenascin-C (TN-C) levels in patients with acute myocardial infarction (AMI).

BACKGROUND: Tenascin-C, an extracellular matrix glycoprotein, is not normally expressed in the adult heart, but transiently appears during pathological conditions and plays important roles in tissue remodeling.

METHODS: Serum TN-C levels were measured by ELISA in 105 AMI patients at various time points, in 10 old myocardial infarction (OMI) patients, and 20 normal controls.

RESULTS: The mean serum TN-C level of AMI patients on admission (63.3 ± 30.1 ng/ml) was significantly higher than that of controls and OMI (30.9 ± 8.8 ng/ml and 27.4 ± 11.7 ng/ml, respectively, p < 0.01), and peaked at 5 days (83.2 ± 43.0 ng/ml). Follow-up examination (mean: 43.9 ± 19.6 months) revealed that 25 of 105 AMI (23.8%) patients showed left ventricular (LV) remodeling (20% end-diastolic volume increase), and in 15 (14.3%), major adverse cardiac events (MACE) were detected. The peak TN-C level was significantly higher in the remodeling group than the nonremodeling group (112 ± 37 ng/ml vs. 66 ± 29 ng/ml; p < 0.0001). By receiver-operating characteristic (ROC) analysis, TN-C levels clearly discriminated prediction of LV remodeling and MACE compared with other variables including plasma B-type natriuretic peptide, creatine kinase-MB, and LV function. Best predictive values of TN-C for remodeling and MACE were 84.8 and 92.8 ng/ml, respectively. Cox proportional hazards model analysis showed that TN-C was an important independent predictor of MACE.

CONCLUSIONS: The findings suggest that serum TN-C levels might be useful in predicting LV remodeling and prognosis after AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CHF = congestive heart failure   LV = left ventricle   LVEDV = left ventricular end-diastolic volume   LVESV = left ventricular end-systolic volume   MACE = major cardiac adverse events   MMP = matrix metalloproteinase   OMI = old myocardial infarction   ROC = receiver-operating characteristic   SPECT = single photon emission computerized tomography   TDS = total defect score   TN-C = tenascin-C

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