Skip to main content

Advertisement

SpringerLink
Log in

Proinflammatory cytokines in acute myocardial infarction with and without cardiogenic shock

  • ORIGINAL PAPER
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Inflammatory response is an important feature of acute coronary syndromes and myocardial infarction (MI). The prognostic value of proinflammatory cytokines in patients with acute MI complicated by cardiogenic shock is unknown.

Methods and results

In 41 patients admitted with acute MI (age 60 ± 11 years, six females, 19 Killip class IV) serial plasma concentration of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1Ra) were measured. Seven patients with cardiogenic shock (CS) developed a systemic inflammatory response syndrome (SIRS). Patients with CS—particularly those who developed SIRS—showed significantly higher cytokine levels than patients with uncomplicated MI. In patients with CS and SIRS peak levels of IL-1Ra were 223,973 pg/ml, IL-6 252.8 pg/ml and TNF-α 7.0 pg/ml. In CS without SIRS IL-1Ra levels were 19,988 pg/ml, IL-6 109.3 pg/ml and TNF-α 3.8 pg/ml. In uncomplicated MI peak IL-1Ra levels were 1,088 pg/ml, IL-6 34.1 pg/ml and TNF-α 2.6 pg/ml.

Conclusions

The inflammation-associated cytokines TNF-α, IL-6 and IL-1Ra are significantly elevated in patients with MI complicated by CS when compared to patients with uncomplicated MI. Among shock-patients IL-1Ra levels are promising diagnostic markers for early identification of patients developing SIRS, heralding a poor outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Akira S, Hirano T, Taga T et al. (1990) Biology of multifunctional cytokines: IL 6 and related molecules (IL 1 and TNF). FASEB J 4:2860–2867

    PubMed  CAS  Google Scholar 

  2. Arai KI, Lee F, Miyajima A et al. (1990) Cytokines: coordinators of immune and inflammatory responses. Annu Rev Biochem 59:783–836

    Article  PubMed  CAS  Google Scholar 

  3. Biasucci LM (1996) Elevated Levels of Interleukin-6 in Unstable Angina. Circulation 94:874–877

    PubMed  CAS  Google Scholar 

  4. Biasucci LM, Liuzzo G, Fantuzzi G et al. (1999) Increasing levels of interleukin (IL)-1Ra and IL-6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in-hospital coronary events. Circulation 99:2079–2084

    PubMed  CAS  Google Scholar 

  5. Cannon JG, Tompkins RG, Gelfand JA et al. (1990) Circulating interleukin-1 and tumor necrosis factor in septic shock and experimental endotoxin fever. J Infect Dis 161:79–84

    PubMed  CAS  Google Scholar 

  6. Casey LC, Balk RA, Bone RC (1993) Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Int Med 119:771–778

    PubMed  CAS  Google Scholar 

  7. Dinarello CA (2000) Proinflammatory cytokines. Chest 118:503–508

    Article  PubMed  CAS  Google Scholar 

  8. Fischer E, Van Zee KJ, Marano MA et al. (1992) Interleukin-1 receptor antagonist circulates in experimental inflammation and in human disease. Blood 79:2196–2200

    PubMed  CAS  Google Scholar 

  9. Gabay C (2002) Cytokine inhibitors in the treatment of rheumatoid arthritis. Expert Opin Biol Ther 2:135–149

    Article  PubMed  CAS  Google Scholar 

  10. Garces K (2001) Anakinra: interleukin-1 receptor antagonist therapy for rheumatoid arthritis. Issues Emerg Health Technol 1–4

  11. Ghezzi P, Dinarello CA, Bianchi M et al. (1991) Hypoxia increases production of interleukin-1 and tumor necrosis factor by human mononuclear cells. Cytokine 3:189–194

    Article  PubMed  CAS  Google Scholar 

  12. Granowitz EV, Santos AA, Poutsiaka DD et al. (1991) Production of interleukin-1-receptor antagonist during experimental endotoxaemia. Lancet 338:1423–1424

    Article  PubMed  CAS  Google Scholar 

  13. Hasdai D, Holmes DR Jr., Topol EJ et al. (1999) Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase. Results from GUSTO-III. Global Use of Strategies to Open Occluded Coronary Arteries. Eur Heart J 20:128–135

    Article  PubMed  CAS  Google Scholar 

  14. Hegewisch S, Weh HJ, Hossfeld DK (1990) TNF-induced cardiomyopathy. Lancet 335:294–295

    Article  PubMed  CAS  Google Scholar 

  15. Herrera-Garza EH, Stetson SJ, Cubillos-Garzon A et al. (1999) Tumor necrosis factor-alpha: a mediator of disease progression in the failing human heart. Chest 115:1170–1174

    Article  PubMed  CAS  Google Scholar 

  16. Hirschl MM, Gwechenberger M, Binder T et al. (1996) Assessment of myocardial injury by serum tumour necrosis factor alpha measurements in acute myocardial infarction. Eur Heart J 17:1852–1859

    PubMed  CAS  Google Scholar 

  17. Hochman JS, Sleeper LA, Webb JG et al. (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634

    Article  PubMed  CAS  Google Scholar 

  18. Hochman JS, Sleeper LA, White HD et al. (2001) One-year survival following early revascularization for cardiogenic shock. JAMA 285:190–192

    Article  PubMed  CAS  Google Scholar 

  19. Kohsaka S, Menon V, Lowe AM et al. (2005) Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med 165:1643–1650

    Article  PubMed  Google Scholar 

  20. Levine B, Kalman J, Mayer L et al. (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–241

    PubMed  CAS  Google Scholar 

  21. Mantovani A, Bussolino F, Dejana E (1992) Cytokine regulation of endothelial cell function. FASEB J 6:2591–2599

    PubMed  CAS  Google Scholar 

  22. Millar AB, Foley NM, Singer M et al. (1989) Tumour necrosis factor in bronchopulmonary secretions of patients with adult respiratory distress syndrome. Lancet 2:712–714

    Article  PubMed  CAS  Google Scholar 

  23. Moser R, Schleiffenbaum B, Groscurth P et al. (1989) Interleukin 1 and tumor necrosis factor stimulate human vascular endothelial cells to promote transendothelial neutrophil passage. J Clin Invest 83:444–455

    Article  PubMed  CAS  Google Scholar 

  24. Neumann FJ, Ott I, Gawaz M et al. (1995) Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation 92:748–755

    PubMed  CAS  Google Scholar 

  25. Schuler J, Maier B, Behrens S et al. (2006) Present treatment of acute myocardial infarction in patients over 75 years. Clin Res Cardiol 95:360–367

    Article  PubMed  Google Scholar 

  26. Shigematsu S (1998) Therapeutic potential of interleukin-1 receptor antagonist in inflammatory bowel disease. Kurume Med J 45:175–179

    PubMed  CAS  Google Scholar 

  27. Sturk A, Hack CE, Aarden LA et al. (1992) Interleukin-6 release and the acute-phase reaction in patients with acute myocardial infarction: a pilot study. J Lab Clin Med 119:574–579

    PubMed  CAS  Google Scholar 

  28. Suffredini AF, Fromm RE, Parker MM et al. (1989) The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 321:280–287

    PubMed  CAS  Google Scholar 

  29. Torre-Amione G, Kapadia S, Lee J et al. (1996) Tumor necrosis factor-alpha and tumor necrosis factor receptors in the failing human heart. Circulation 93:704–711

    PubMed  CAS  Google Scholar 

  30. Vaddi K (1994) Increased secretion of tumor necrosis factor-α and interferon-γ by mononuclear leukocytes in patients with ischemic heart disease. Circulation 90:694–699

    PubMed  CAS  Google Scholar 

  31. van der Poll T, Levi M, Hack CE et al. (1994) Elimination of interleukin 6 attenuates coagulation activation in experimental endotoxemia in chimpanzees. J Exp Med 179:1253–1259

    Article  PubMed  Google Scholar 

  32. Werra Id. (1997) Cytokines, nitrite/nitrate, soluble tumor necrosis factro receptors, and procalcitonin concentrations: compaision in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 25:607–613

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the efforts of the entire team of the central laboratory. The study would not have been possible without the dedicated efforts of the laboratory technicians and the ICU-staff of the Triemli Hospital.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine , Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland

    Marianne Debrunner MD, Ernst Schuiki MD, Edwin Straumann MD, Barbara Naegeli MD, Raymond Mury MD, Osmund Bertel MD & Jürgen Frielingsdorf MD

  2. Central Laboratory, Stadtspital Triemli, 8063, Zurich, Switzerland

    Elisabeth Minder MD

Authors
  1. Marianne Debrunner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ernst Schuiki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabeth Minder MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edwin Straumann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Naegeli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raymond Mury MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Osmund Bertel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jürgen Frielingsdorf MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jürgen Frielingsdorf MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Debrunner, M., Schuiki, E., Minder, E. et al. Proinflammatory cytokines in acute myocardial infarction with and without cardiogenic shock. Clin Res Cardiol 97, 298–305 (2008). https://doi.org/10.1007/s00392-007-0626-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-007-0626-5

Key words

Search

Navigation