Association of myocardial edema, hemorrhage and persistent microvascular obstruction with circulating inflammatory biomarkers in acute myocardial infarction patient

Abstract

Although early reperfusion, ST-elevation myocardial infarction (STEMI) remain a major cause of mortality and heart failure. Reperfusion is commonly associated with persistent micro-vascular obstruction (MVO), edema and intramyocardial hemorrhage (IMH) which are detected using cardiovascular magnetic resonance (CMR) imaging. Furthermore, STEMI is associated with an important inflammatory reaction. So far, the correlation between CMR parameters and inflammation remain unclear. This study aims at deciphering the correlation between adverse events and inflammatory biomarkers. This is a prospective study including 21 STEMI patients referred for a primary percutaneous coronary intervention. Seven blood samples were collected at admission, 4, 12, 24, 48 hours, 7 and 30 days after reperfusion. The presence of inflammatory markers including fibrinogen, inteleukin-10, interleukine-6, C reactive protein (CRP), interleukine-8, and neutrophils count was assessed by enzyme-linked immunosorbent assay (ELISA) technique. At day 7 after reperfusion, CMR was performed to determine infarct size, MVO, IMH and edema. The study compares the expression level of each biomarker with CMR measures. MVO was present in 55% of patients and IMH in 33.3%. We observed a correlation between IL-6, CRP, fibrinogen, neutrophil levels and IMH ( P = 0.033; P = 0.05; P = 0.0085; P = 0.0046 respectively). Patients with persistent MVO present a significantly higher rate of CRP ( P = 0.0125). No significant difference was found for other markers and edema was not significantly correlated with inflammation. Following acute myocardial infarction in human patient, IMH appears to be strongly correlated with inflammatory biomarkers. Targeting the couple IMH/inflammation could be a novel strategy in future adjunctive STEMI treatment.