Published online before print June 21, 2004, doi: 10.1161/01.CIR.0000133316.92316.81
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(Circulation. 2004;110:46-50.)
© 2004 American Heart Association, Inc.
Original Articles |
Widespread Myocardial Inflammation and Infarct-Related Artery Patency
From the Institute of Cardiology, Catholic University, Rome, Italy (A.A., G.G.L.B.-Z., G.L., A.M.L., L.M.B., F.C.); the Division of Pathologic Anatomy, University of Rome "Tor Vergata," Rome, Italy (E.B., A.M., L.G.S.); the Department of Pathologic Anatomy and of Pathology, University of Trieste, Trieste, Italy (R.B., F.S., A.D.); the Department of Biochemistry "F. Cedrangolo," Pathologic Anatomy, Second University of Naples, Naples, Italy (F.B., A.B.); and the Institute of Internal Medicine, Catholic University, Rome, Italy (F.P.).
Correspondence to Antonio Abbate, MD, 10025 Bellona Ct, Richmond, VA 23238. E-mail abbatea{at}yahoo.com
Received December 15, 2003; revision received March 9, 2004; accepted March 11, 2004.
Background— Diffuse coronary vascular inflammation is associated with acute coronary syndromes. However, it is unknown whether inflammation also occurs within the myocardium. Therefore, this study was aimed at assessing the presence of activated cells in unaffected remote myocardium of patients with acute myocardial infarction (AMI), in comparison to the peri-infarct region from the same cases, and in comparison to myocardial specimens from control hearts.
Methods and Results— Sixteen patients dying 1 to 12 weeks after AMI and 16 control subjects were selected at autopsy. Myocardial specimens were taken at remote unaffected viable regions and at peri-infarct regions in cases with AMI. Confocal microscopy was performed to measure the number of activated cells (DR+), T-lymphocytes (CD3+), and activated T-lymphocytes (CD3+/DR+). Activated cells and activated T-lymphocytes were found in remote unaffected regions in 11 of 16 cases (69%), in peri-infarct zone in all cases (100%), and in none of the control hearts (0%, P<0.001 versus others). A greater myocardial inflammatory burden in remote regions but not in peri-infarct regions was associated with persistent infarct-related artery occlusion (P<0.05).
Conclusions— This study for the first time shows the presence of activated T-lymphocytes in remote unaffected myocardial regions in approximately two thirds of patients with recent AMI. Because these cells are associated with persistent infarct-related artery occlusion, our data may suggest that an antigenic stimulus present also in the myocardium triggers an immune response that may be critical to precipitate artery occlusion. (Circulation. 2004;110:46-50.)
Key Words: inflammation • myocardial infarction • lymphocytes • immune system
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