Incidence and significance of heartmuscle antibodies in patients with acute myocardial infarction and unstable angina

Serum concentrations of immunoglobulins and free light chains before and after vascular events in essential hypertension

Serum concentrations of immunoglobulins (Ig) and free light chains (LC) of Ig have been determined at regular intervals during five years in patients with essential hypertension and correlated to development of vascular complications. In 6 cardiac event patients serum IgG increased by 11.9% (p less than 0.05) and LC by 19.8% (p less than 0.05). IgG levels correlated positively with LC levels (r = 0.59, p less than 0.001) and changes in IgG correlated positively with changes in LC (r = 0.46, p less than 0.01). The post-event increments in IgG persisted up to 21 months. No significant changes in serum concentrations of IgA, IgM, albumin and creatinine were found. In 10 cerebral event patients and in matched groups of 15 uncomplicated hypertensive patients, no significant changes in the above parameters could be demonstrated. It is concluded that heart tissue damage in essential hypertension induces a long-lasting stimulation of B-lymphocytes, and it is suggested that the high Ig levels found in as yet uncomplicated hypertensive patients may reflect an ongoing damage of the vascular bed.

Relation of Antimyocardium Antibodies to Mortality in Patients with Acute Myocardial Infarction

BACKGROUND

Antimyocardium antibodies (AMA) have been observed in patients with acute myocardial infarction (AMI). At present it is unknown if these AMA play a role in the pathogenesis of acute or chronic myocardial damage or if they are only produced as a result of tissue destruction, disappearing later without clinical manifestations. However, some studies have shown that patients with AMI and AMA have higher possibilities of presenting heart failure and death. The aim of the present study was to determine if there is an association (odds ratio, OR) between AMA and death in patients with AMI.

METHODS

The design was a cross-sectional study. One hundred patients with acute myocardial infarction were recruited consecutively at the Coronary Care Unit of the Hospital de Especialidades at La Raza National Medical Center, IMSS, Mexico City. IgG antimyocardium antibodies were identified using the enzyme-linked immunosorbent assay technique (ELISA).

RESULTS

Of the 100 patients studied, 81 were males and 19 females, with an average age of 58 +/- 11 years. Of the population studied, 44% showed AMA. It was observed that patients with positive AMA had an OR for heart failure of 3.40 (CI 95% 0.97-12.5, p = 0.06) and for death of 7.94 (CI 95%, 1.49-56.1, p = 0.003). This variable was analyzed with other confounding variables using logistic regression, and an OR of 11.8 (CI 95% 1.63-86.3, p = 0.001) was obtained.

CONCLUSIONS

AMAs were an independent predictive factor for mortality in patients with AMI.

Postcardiac injury syndrome. An immunologic pleural fluid analysis

The postcardiac injury syndrome (PCIS) is characterized by inflammation of the pericardium, pleura, and pulmonary parenchyma following a variety of cardiac injuries. Although it has been clinically recognized for decades, confirmation of the syndrome has been problematic owing to lack of a sufficiently diagnostic test. Previously, we have reported pleural fluid characteristics which help to exclude other diagnoses that may mimic the syndrome. We describe the first immunologic assessment, including antimyocardial antibody testing, of pleural fluid from a patient with PCIS which supports a local immunologic mechanism in the pathogenesis of the syndrome. These results support the important role of pleural fluid analysis in the diagnosis of PCIS.

Rheumatic symptoms after cardiac surgery: a prospective study

The incidence of different types of shoulder pain after open heart surgery was studied prospectively. Of 101 patients studied, 45 developed rheumatic symptoms during the first six weeks after the operation. Thirty eight patients reported pain in the region of the shoulder girdle with no loss of shoulder function (postpericardiotomy rheumatism). Three of these patients also had features compatible with the postpericardiotomy syndrome (fever, malaise, or pleuritic chest pain), and seven developed the syndrome without pain in the shoulder girdle. Of these 10 patients, one had generalised myalgia. Postpericardiotomy rheumatism alone was not associated with increased inflammation (measured by the erythrocyte sedimentation rate and concentration of C reactive protein); immunological tests including measurement of antibodies to cardiac muscle yielded inconclusive results. Replies to a postal questionnaire showed that symptoms of postpericardiotomy rheumatism were present for over three months in 18 patients and for six months or longer in 14. In view of the large number of patients now having open heart surgery postpericardiotomy rheumatism should be considered when patients report pain around the shoulders so that it is not misdiagnosed as angina.

Characteristics, prevalence, and prognosis of postmyocardial infarction syndrome

Among 1809 patients with myocardial infarction, 60 (3.3%) later developed a postmyocardial infarction syndrome. These 60 patients were compared with controls with myocardial infarction but without postmyocardial infarction syndrome. Cases with postmyocardial infarction syndrome had larger and more complicated infarcts than control subjects. Five year cumulative mortality was higher among cases (26%) than among control subjects (18%) but this difference was not statistically significant. Corticosteroid treatment did not adversely affect the prognosis of the postmyocardial infarction syndrome, which we conclude is mainly determined by the severity of the underlying coronary heart disease.

Current incidence of postmyocardial infarction (Dressler's) syndrome

This study examines the current incidence of postmyocardial infarction (Dressler's) syndrome. During 1980, 282 patients with documented myocardial infarction were admitted to our coronary care unit. Early postmyocardial infarction pericarditis was present in 18 patients (6.4%). Six of these patients received steroids and the remainder were treated with salicylates or other anti-inflammatory drugs. Anticoagulation was used in 149 patients (53%) during hospitalization. One hundred forty-four (51%) were receiving heparin and 133 (47%) received no anticoagulation. Information on the patient's status at 6 months was available in 229 patients who were discharged alive. Sixteen patients had died within 6 months after discharge and 4 patients were lost to follow-up study. There were no documented cases of Dressler's syndrome. It is concluded that Dressler's syndrome has decreased in incidence and perhaps disappeared. This decrease is most likely related to decreased use of oral anticoagulants and to more aggressive treatment of postmyocardial infarction pericarditis.