[The early predictors of ventricular remodeling after myocardial infarction: the role of tumor necrosis factor-alpha].
OBJECTIVE
Ventricular remodeling (VR) is a pathologic process characterized by progressive ventricular dilatation occurring after acute myocardial infarction (MI) leading to left ventricular systolic dysfunction. The purpose of the study was to evaluate the efficacy of plasma tumor necrosis factor alpha (TNF-alpha) levels to predict the left VR.


METHODS
This prospective observational cohort study included 72 consecutive patients with newly diagnosed MI with age ranging between 38-87 years (mean 59 +/- 12 years). Control group was consisted of 30 patients with no additional systemic disease and normal coronary arteriograms. Transthoracic echocardiography was performed to all patients and controls both in the beginning of the study and in the 6th follow-up. A coronary arteriography was also performed to all patients. Patients with an increment in the diastolic volume index more than 20% in the follow-up compared with basal values included in the VR subgroup. The patient subgroup with VR consisted of 19 patients. Statistical analyses were performed using ANOVA and Kruskal Wallis tests for comparison of variables between groups. Logistic regression and ROC analyses were used for evaluation of accuracy of TNF-alpha in prediction of VR.


RESULTS
There were no significant differences between groups according to demographic characters. The basal plasma levels of TNF-alpha were higher in the patient subgroup with VR as compared with patients without VR and controls (14.59 +/- 4.28 pg/ml vs 7.30 +/- 4.48 pg/ml, and 1.64 +/- 1.49 pg/ml, p< 0.001). In logistic regression analysis only TNF-alpha predicted the VR (OR-1.356, 95% CI 1.117-1.647). Plasma TNF-alpha levels with a cut-off > or = 10.33 pg/ml were found to have 89.5% sensitivity and 79.3% specificity to predict the development of VR.


CONCLUSIONS
These results demonstrate the increment of plasma TNF-alpha levels in the acute phase of MI and the close relationship between the TNF-alpha levels and VR in the patients with first MI.
Kaya
Ergün Bariş
EB
Hacettepe Universitesi, Tip Fakültesi Kardiyoloji Anabilim Dali, Ankara, Türkiye. doctorkaya@yahoo.com
Ozer
Necla
N
Deveci
Onur Sinan
OS
Kepez
Alper
A
Tülümen
Erol
E
Aksöyek
Serdar
S
Atalar
Enver
E
Ovünç
Kenan
K
Ozmen
Ferhan
F
Ozkutlu
Hilmi
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D015331:Cohort Studies; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D020257:Ventricular Remodeling
D014409:Tumor Necrosis Factor-alpha