title: Prognostic value of activated toll-like receptor-4 in monocytes following acute myocardial infarction.
abstract: This study tested the hypothesis that activated toll-like receptor-4 (TLR-4) is closely related to combined major adverse clinical outcomes (MACO) [defined as advanced Killip score (> or = 3), overt congestive heart failure (CHF) (New York Heart Association functional class > or = 2) or 30-day death] in patients with ST-segment elevation (ST-se) acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). We conducted a prospective cohort study in 43 consecutive patients with ST-se AMI of onset < 12 hours who were undergoing primary PCI. Blood samples for TLR-4 and serum level of tumor necrosis factor-alpha (TNF-alpha) were collected from 43 patients at 24 hours after AMI and from 20 normal outpatients. The experimental results revealed significantly higher baseline levels of TLR-4, TNF-alpha and white blood cell (WBC) count in the study patients than in normal control subjects (all P < 0.0001). Additionally, baseline levels of TLR-4, TNF-alpha , creatinine, peak level of CK-MB, and multiple vessel disease were significantly higher, whereas left ventricular performance was notably lower in patients (n = 18) with occurrence of MACO than in patients (n = 25) without occurrence of MACO (all P < 0.05). Furthermore, the level of lipopolysaccharide (LPS)-stimulated LTR-4 was significantly increased in MACO patients than in those without MACO (P < 0.0001). Moreover, LPS-stimulated TLR-4 was the most independent predictor of 30-day MACO (P < 0.01). In patients with ST-se AMI, activated TLR-4 is independently predictive of 30-day MACO.
authors: Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC..
authors: Jiunn-Jye
authors: JJ
authors: Sheu
authors: Li-Teh
authors: LT
authors: Chang
authors: Chiang-Hua
authors: CH
authors: Chiang
authors: Ali A
authors: AA
authors: Youssef
authors: Chiung-Jen
authors: CJ
authors: Wu
authors: Fan-Yen
authors: FY
authors: Lee
authors: Hon-Kan
authors: HK
authors: Yip
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000737:chemistry*; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D051197:Toll-Like Receptor 4 / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D051197:Toll-Like Receptor 4; D014409:Tumor Necrosis Factor-alpha; D003404:Creatinine