Predictive inflammatory biomarkers for left ventricular thrombus in acute myocardial infarction

Abstract

Left ventricular thrombus (LVT) is a complication caused by acute myocardial infarction (MI). In addition to anterior localization and low left ventricular ejection fraction (LVEF), some studies suggest an association between LVT and the level of inflammatory biomarkers. The aim of our study was to assess the relationship between inflammatory biomarkers at the acute phase of MI and the presence of LVT assessed by cardiac magnetic resonance (CMR) in acute ST-elevation MI patients. In total, 187 patients with acute STEMI were included in the prospective HIBISCUS cohort. Blood samples were collected at 5 time-points: upon admission, 4, 24, 48 hours after admission (H4, H24, H48) and at 1 month (M1). Three groups of inflammatory biomarkers serum levels were assessed using ELISA assays at each time-point. Cellular biomarkers were assessed using fluorescence-activated cell sorting. All patients had a complete CMR study at one month. STEMI patients had a median age of 56 years [50–63], and 50% ( n = 101) had an anterior MI. Twenty-eight patients (15.0%) had an LVT. Patients with LVT presented a higher peak of interleukin-6 (IL-6) compared to patients without LVT (9.4 pg/mL [5.3–17.8] versus 4.2 pg/mL [1.9–9.9], respectively; P = 0.02). They also presented significantly higher peaks of suppressor tumor 2 (ST2) (34.9 ng/mL [21.0–59.9] versus 22.1 ng/mL [13.0–33.9], P = 0.0005), vascular cell adhesion molecule 1 (VCAM-1) (413 ng/L [363–535] versus 333 ng/L [282–434], P < 0.005), and C-reactive protein (47.4 mg/L [16.3–99.8] versus 12.0 mg/L [6.7–42.7], P = 0.004). Patients with LVT had higher numbers of monocytes (1.2 G/L [1.0–1.4] versus 0.9 G/L [0.7–1.1], P = 0.0001) and neutrophils (9.8 G/L [8.1–10.9] versus 7.2 G/L [5.5–9.1], P = 0.0002) compared to patients without. In the multivariate analysis adjusting on LVEF and infarct size (IS), only peak levels of monocytes, neutrophils and VCAM-1 remained significantly associated with LVT. High levels of circulating ST2, IL-6, VCAM-1, CRP, neutrophils and monocytes were associated with an increased risk of LV thrombus after STEMI.