title: Plasma interleukin-18 concentration: a novel marker of myocardial ischemia rather than necrosis in humans.
abstract: OBJECTIVE
  Myocardial ischemia contributes to cytokine expression in the myocardium in animals; therefore, plasma interleukin-18 concentration may be a good marker of myocardial ischemia/injury in patients with possible acute coronary syndrome. We sought to determine whether increases in plasma interleukin-18 concentrations might be indicative of myocardial ischemia in patients with acute coronary syndrome.
  
  
  METHODS
  Plasma interleukin-18 concentrations were assessed in 27 acute coronary syndrome patients in whom creatine kinase activity was within normal range on admission, in addition to 10 controls. Myocardial infarction was retrospectively evidenced in 15 of the 27 patients. All patients with acute coronary syndrome were treated by emergent coronary interventions just after admission. Blood sampling was done immediately after admission to determine plasma IL-18 concentration and biochemical markers of myocardial infarction.
  
  
  RESULTS
  An increase in plasma interleukin-18 concentration was observed in acute coronary syndrome patients on admission, regardless of the retrospective evidence of myocardial necrosis. Plasma interleukin-18 elevation preceded creatine kinase-MB elevation in myocardial infarction patients. Plasma interleukin-18 concentrations on admission did not correlate with peak creatine kinase-MB (r=0.38, P=n.s.) or with left ventricular ejection fraction (r=-0.14, P=n.s.).
  
  
  CONCLUSIONS
  Plasma interleukin-18 concentration elevates quickly after severe myocardial ischemic event regardless of evolving myocardial necrosis. Thus, plasma interleukin-18 concentration may be a good and early marker to identify whether the symptom is due to myocardial ischemia, and therefore, may be used in deciding the therapeutic strategy in individual patients with possible acute coronary syndrome.
authors.affiliation: Department of Internal Medicine, Cardiovascular Division Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Shinji
authors.initials: S
authors.lastname: Morimoto
authors.forename: Miho
authors.initials: M
authors.lastname: Masai
authors.forename: Motomaru
authors.initials: M
authors.lastname: Masutani
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Ohyanagi
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Kashiwamura
authors.forename: Haruki
authors.initials: H
authors.lastname: Okamura
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000097:blood*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D011237:Predictive Value of Tests
chemical_list: D015415:Biomarkers; D020382:Interleukin-18; D052279:Creatine Kinase, MB Form