Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction: A possible role for left ventricular remodeling
Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction: A possible role for left ventricular remodeling
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DOI：
10.1016/s0735-1097(01)01721-1
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发表时间：
2002-01-16
影响因子：
24
通讯作者：
Ogawa, S
中科院分区：
文献类型：
--
作者：
Maekawa, Y;Anzai, T;Ogawa, S
本研究的目的是确定外周单核细胞增多症在再灌注急性心肌梗死（AMI）后的临床结果中的意义，特别是与梗死后左心室（LV）remodeling.Background外周单核细胞增多症发生在AMI后2 - 3天，反映了单核细胞和巨噬细胞浸润到坏死心肌中。然而，AMI后外周单核细胞增多的预后意义仍有待确定。方法共149例首次Q波AMI患者进行了研究。AMI后每24 h检测一次外周血白色细胞（WBC）计数、单核细胞百分比及血清C反应蛋白（CRP）水平，连续检测4 d。我们评估了外周血单核细胞增多症与包括泵衰竭、左室动脉瘤和AMI后长期预后在内的预后之间的关系。结果泵衰竭（p < 0.0001）或左室动脉瘤（p = 0.005）患者的单核细胞峰值计数高于无这些并发症的患者。出院前左心室造影显示单核细胞峰值计数与左心室舒张末期容积呈正相关（p = 0.024），与射血分数呈负相关（p = 0.023）。多变量分析显示单核细胞峰值计数大于或等于900/mm 3是泵衰竭的独立决定因素（相对风险[RR] 9.83，p < 0.0001），左心室动脉瘤（RR 4.78，p = 0.046）和心脏事件（RR 6.30，p < 0.0001），包括因心力衰竭再入院，再发心肌梗死和心源性死亡，包括猝死。结论外周单核细胞增多症与左室功能障碍和左室动脉瘤相关，提示单核细胞在AMI再灌注后LV重构的发展中可能起作用。(C)2002年由美国心脏病学会发布。
OBJECTIVES The aim of this study was to determine the significance of peripheral monocytosis in clinical outcome after reperfused acute myocardial infarction (AMI), especially relating to post-infarct left ventricular (LV) remodeling.BACKGROUND Peripheral monocytosis occurs two to three days after AMI, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. However, the prognostic significance of peripheral monocytosis after AMI remains to be determined.METHODS A total of 149 patients with first Q-wave AMI were studied. White blood cell (WBC) count, percentage of monocytes and serum C-reactive protein level were measured every 24 h for four days after the onset of AMI. We assessed association between peripheral monocytosis and prognosis including pump failure, LV aneurysm and long-term outcome after AMI.RESULTS Patients with pump failure (p < 0.0001) or LV aneurysm (p = 0.005) had higher peak monocyte counts than those without these complications. Predischarge left ventriculography revealed that peak monocyte count was positively correlated with LV end-diastolic volume (p = 0.024) and negatively correlated with ejection fraction (p = 0,023). Multivariate analyses showed that peak monocyte count greater than or equal to900/mm(3) was an independent determinant of pump failure (relative risk [RR] 9.83, p < 0.0001), LV aneurysm (RR 4.78, p = 0.046) and cardiac events (RR 6.30, p < 0.0001), including readmission for heart failure, recurrent myocardial infarction and cardiac deaths, including sudden deaths.CONCLUSIONS Peripheral monocytosis is associated with LV dysfunction and LV aneurysm, suggesting a possible role of monocytes in the development of LV remodeling after reperfused AMI. (C) 2002 by the American College of Cardiology.