Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction: A possible role for left ventricular remodeling

Yuichiro Maekawa, Toshihisa Anzai, Tsutomu Yoshikawa, Yasushi Asakura, Toshiyuki Takahashi, Shiro Ishikawa, Hideo Mitamura, Satoshi Ogawa

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215 Citations (Scopus)

Abstract

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 ≥900/mm3 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.

Original languageEnglish
Pages (from-to)241-246
Number of pages6
JournalJournal of the American College of Cardiology
Volume39
Issue number2
DOIs
Publication statusPublished - 2002 Jan 16

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Ventricular Remodeling
Myocardial Infarction
Monocytes
Aneurysm
Left Ventricular Dysfunction
Sudden Death
Leukocyte Count
Stroke Volume
C-Reactive Protein
Blood Proteins
Myocardium
Multivariate Analysis
Heart Failure
Macrophages

ASJC Scopus subject areas

  • Nursing(all)

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Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction : A possible role for left ventricular remodeling. / Maekawa, Yuichiro; Anzai, Toshihisa; Yoshikawa, Tsutomu; Asakura, Yasushi; Takahashi, Toshiyuki; Ishikawa, Shiro; Mitamura, Hideo; Ogawa, Satoshi.

In: Journal of the American College of Cardiology, Vol. 39, No. 2, 16.01.2002, p. 241-246.

Research output: Contribution to journalArticle

Maekawa, Yuichiro ; Anzai, Toshihisa ; Yoshikawa, Tsutomu ; Asakura, Yasushi ; Takahashi, Toshiyuki ; Ishikawa, Shiro ; Mitamura, Hideo ; Ogawa, Satoshi. / Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction : A possible role for left ventricular remodeling. In: Journal of the American College of Cardiology. 2002 ; Vol. 39, No. 2. pp. 241-246.
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AU - Maekawa, Yuichiro

AU - Anzai, Toshihisa

AU - Yoshikawa, Tsutomu

AU - Asakura, Yasushi

AU - Takahashi, Toshiyuki

AU - Ishikawa, Shiro

AU - Mitamura, Hideo

AU - Ogawa, Satoshi

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N2 - 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 ≥900/mm3 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.

AB - 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 ≥900/mm3 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.

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