Is Inflammation Related to the Clinical Severity of Unstable Angina?

Inverse correlation between soluble CD40 ligand and soluble CD40 is absent in patients with unstable angina

The CD40/CD40 ligand (CD40L) system mediates inflammatory processes important in atherogenesis and plaque instability. The expression of CD40L on activated T cells was suppressed by soluble CD40 (sCD40) in vitro. However, the relationship between soluble CD40L (sCD40L) and sCD40 in unstable angina (UA) is still unknown. Thirty-seven consecutive patients with recent chest pain or discomfort were recruited. Patients with both Braunwald's class IB-IIIB and with coronary stenosis (or stenoses) of >75% were assigned to the UA group (n = 19, aged 67.2 +/- 8.2 years), and the rest to the control group (n = 18, aged 63.4 +/- 8.7 years). The serum levels of sCD40L and sCD40, and the plasma levels of matrix metalloproteinase (MMP)-9, were measured by enzyme-linked immunosorbent assays. A significantly inverse correlation between sCD40L and sCD40 was shown in the controls (r = -0.72, P = 0.0007), but was absent in the UA group (r = -0.16, P not significant), although there was no statistical significance between these groups in terms of serum levels of sCD40L or sCD40. The difference of the regression slopes of these regression lines was statistically significant (P < 0.01). Additionally, there was a significant correlation between sCD40 and plasma levels of MMP-9 in the patients with and without UA (r = 0.58, P = 0.0096), but no significant correlation between sCD40L and MMP-9 levels (r = 0.00, P not significant). The balance between CD40 and CD40L may be lost in patients with UA. Soluble CD40 expression may also be related to MMP-9 expression in atherosclerotic tissues.

Significance of Neutrophil Counts After Reperfusion Therapy in Patients With a First Anterior Wall Acute Myocardial Infarction

BACKGROUND

Previous studies have demonstrated that an elevated neutrophil count on admission is associated with a higher risk of adverse events after acute myocardial infarction (AMI). However, the significance of the neutrophil count after reperfusion therapy has not been elucidated.

METHODS AND RESULTS

The association of the neutrophil count on admission and days 2 and 3 with peak creatine kinase (CK) concentration, ST-segment resolution (a marker of myocardial tissue-level reperfusion), and left ventricular (LV) function at predischarge were examined in 122 patients (102 men, 20 women, mean age 61+/-11 years) with a first anterior wall AMI. Neutrophil counts were increased on day 2 and decreased on day 3 compared with admission (8,768+/-3,005 mm3, 6,617+/-2,424 mm3, and 7,725+/-3,388 mm3, respectively). Patients with ST-segment resolution (n=52) had lower neutrophil counts on days 2 and 3 than those without it (n=70), but neutrophil counts on admission did not differ significantly between patients with and without ST-segment resolution. Neutrophil counts on admission and days 2 and 3 were weakly but significantly correlated with peak CK concentration (r=0.31, p=0.0004; r=0.43, p<0.0001; r=0.32, p=0.003, respectively) and with LV ejection fraction at predischarge (r=-0.18, p=0.04; r=-0.26, p=0.003; r=-0.27, p=0.003; respectively).

CONCLUSION

The neutrophil count after reperfusion is weakly but significantly correlated with infarct size, myocardial tissue-level reperfusion, and LV function at predischarge in a first anterior wall AMI. These correlations were slightly stronger than the correlations with the neutrophil count on admission.