title: Usefulness of soluble Fms-like tyrosine kinase-1 as a biomarker of acute severe heart failure in patients with acute myocardial infarction.
abstract: Placental growth factor and vascular endothelial growth factor increase angiogenesis and promote healing after acute myocardial infarction (MI), but the significance of soluble Fms-like tyrosine kinase-1 (sFlt-1), an antagonist of placental growth factor and vascular endothelial growth factor, in the setting of acute MI has not been elucidated. The development of acute heart failure in the immediate period after MI is a dreaded complication, but there are no useful biomarkers that identify patients at risk of acute heart failure. We wished to investigate the clinical significance of circulating sFlt-1 during acute MI. We enrolled 174 patients with acute MI, and arterial blood sampling was performed. Plasma levels of sFlt-1 were measured by enzyme-linked immunosorbent assay and their relation to clinical parameters was analyzed. Circulating levels of sFlt-1 on admission were significantly increased in patients with acute MI compared to controls (528.1 +/- 290.9 vs 355.7 +/- 205.0 pg/ml, p <0.001). Circulating levels of sFlt-1 on admission were significantly higher in patients who developed severe acute heart failure requiring mechanical circulatory support devices compared to those with stable hemodynamics (611.4 +/- 373.6 vs 494.6 +/- 243.9 pg/ml, p = 0.016). Moreover, circulating levels of sFlt-1 on admission were directly related to duration of hospitalization. Multivariate logistic analysis showed that hemodynamic instability was predicted by sFlt-1 on admission and left ventricular systolic pressure. In conclusion, the circulating level of sFlt-1 is increased in patients with acute MI, and the sFlt-1 level on admission is a promising biomarker for the development of severe acute heart failure after MI.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Nara, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Onoue
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Yukiji
authors.initials: Y
authors.lastname: Takeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Somekawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Iwama
authors.forename: Taku
authors.initials: T
authors.lastname: Nishida
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Morikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsutsumi
authors.forename: Ji Hee
authors.initials: JH
authors.lastname: Sung
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takemoto
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okayama
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ishigami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawata
authors.forename: Manabu
authors.initials: M
authors.lastname: Horii
authors.forename: Tamio
authors.initials: T
authors.lastname: Nakajima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1