29 / 70
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
AFRICA
299
Relationship between site of myocardial infarction, left
ventricular function and cytokine levels in patients
undergoing coronary artery surgery
Ilker Kiris, Sahin Kapan, Cuneyt Narin, Mehmet Ozaydın, Medine Cumhur Cure, Recep Sutcu,
Huseyin Okutan
Abstract
Background:
The purpose of this study was to examine the
relationship between left ventricular (LV) function, cytokine
levels and site of myocardial infarction (MI) in patients
undergoing coronary artery bypass grafting (CABG).
Methods:
Sixty patients undergoing CABG were divided into
three groups (
n
=
20) according to their history of site of
myocardial infarction (MI): no previous MI, anterior MI and
posterior/inferior MI. In the pre-operative period, detailed
analysis of LV function was done by transthoracic echocar-
diography. The levels of adrenomedullin, interleukin-1-beta,
interleukin-6, tumour necrosis factor-alpha (TNF-
α
) and
angiotensin-II in both peripheral blood samples and pericar-
dial fluid were also measured.
Results:
Echocardiographic analyses showed that the anterior
MI group had significantly worse LV function than both
the group with no previous MI and the posterior/inferior
MI group (
p
<
0.05 for LV end-systolic diameter, fractional
shortening, LV end-systolic volume, LV end-systolic volume
index and ejection fraction). In the anterior MI group, both
plasma and pericardial fluid levels of adrenomedullin and
and pericardial fluid levels of interleukin-6 and interleukin-
1-beta were significantly higher than those in the group with
no previous MI (
p
<
0.05), and pericardial fluid levels of
adrenomedullin, interleukin-6 and interleukin-1-beta were
significantly higher than those in the posterior/inferior MI
group (
p
<
0.05).
Conclusions:
The results of this study indicate that (1) patients
with an anterior MI had worse LV function than patients
with no previous MI and those with a posterior/inferior MI,
and (2) cytokine levels in the plasma and pericardial fluid
in patients with anterior MI were increased compared to
patients with no previous MI.
Keywords:
cytokine, left ventricle, myocardial infarction, coro-
nary artery bypass grafting, pericardium, plasma
Submitted 9/6/14, accepted 8/3/16
Cardiovasc J Afr
2016;
27
: 299–306
www.cvja.co.zaDOI: 10.5830/CVJA-2016-027
Transmural myocardial infarction (MI) results in neurohormonal
activation as a compensation for the impaired contractile force
of the myocardium.
1
This neurohormonal activation is known
to result in the synthesis and release of several cytokines and
growth factors by the injured myocardium into the circulation.
Plasma levels of tumour necrosis factor-alpha (TNF-
α
) and
interleukin-6 (IL-6) have been found to increase in patients
with left ventricular (LV) dysfunction as their functional heart
failure classification deteriorates.
2
Serum concentrations of
pro-inflammatory cytokines such as interleukin-1-beta (IL-1
β
),
IL-6 and high-sensitivity C reactive protein were reported to be
significantly elevated in patients with non-ST elevation acute
coronary syndrome in whom new coronary events developed.
3
Serneri
et al
.
4
reported that the clinical course of heart
failure is associated with a progressive increase in formation of
cardiac angiotensin-II. Yoshitomi
et al
. reported that plasma
adrenomedullin increased in the early phases of acute MI and
was further elevated in patients with congestive heart failure.
5
All
these findings reveal a possible relationship between circulating
levels of pro-inflammatory cytokines and LV function after
acute MI.
In addition to increased cytokine levels in the circulation after
acute MI and congestive heart failure, the injured myocardium
may also produce cytokines locally and subsequently release
them into the pericardial fluid. Since the layers of pericardium
are lined with mesothelial cells, derived from the same stem
cells as vascular endothelial cells, it is speculated that these cells
may also synthesise and release vasoactive substances into the
pericardial fluid.
6
The cytokines in pericardial fluid may reflect
the extent of coronary atherosclerosis and may also directly
promote the atherosclerotic process.
Consistent with this hypothesis, the level of IL-1
β
in pericardial
fluid in patients with ischaemic heart disease was found to be
Department of Cardiovascular Surgery, Medifema Private
Hospital, Izmir, Turkey
Ilker Kiris, MD,
kirisilker@yahoo.comDepartment of Cardiovascular Surgery, Medical Park
Antalya Hospital, Antalya, Turkey
Sahin Kapan, MD
Huseyin Okutan, MD
Department of Cardiovascular Surgery, Egepol Private
Hospital, Izmir, Turkey
Cuneyt Narin, MD
Department of Cardiology, Suleyman Demirel University
Medical School, Isparta, Turkey
Mehmet Ozaydın, MD
Department of Biochemistry, Recep Tayyip Erdogan
University Medical School, Rize, Turkey
Medine Cumhur Cure, MD
Department of Biochemistry, Ataturk Education and
Research Hospital, Katip Celebi University, Izmir, Turkey
Recep Sutcu, MD