Anti-apolipoprotein A-1 IgG as an independent cardiovascular prognostic marker affecting basal heart rate in myocardial infarction.
OBJECTIVE
To assess the prognostic value of anti-apolipoprotein A-1 (anti-apoA-1) IgG after myocardial infarction (MI) and its association with major cardiovascular events (MACEs) at 12 months and to determine their association with resting heart rate (RHR), a well-established prognostic feature after MI. Anti-apoA-1 IgG have been reported in MI without autoimmune disease, but their clinical significance remains undetermined.


RESULTS
A total of 221 consecutive patients with MI were prospectively included, and all completed a 12-month follow-up. Major cardiovascular events consisted in death, MI, stroke, or hospitalization either for an acute coronary syndrome or heart failure. Resting heart rate was obtained on Holter the day before discharge under the same medical treatment. Neonate rat ventricular cardiomyocytes (NRVC) were used in vitro to assess the direct anti-apoA-1 IgG effect on RHR. During follow-up, 13% of patients presented a MACE. Anti-apoA-1 IgG positivity was 9% and was associated with a higher RHR (P = 0.0005) and higher MACE rate (adjusted OR, 4.3; 95% CI, 1.46-12.6; P = 0.007). Survival models confirmed the significant nature of this association. Patients with MACE had higher median anti-apoA-1 IgG values at admission than patients without (P = 0.007). On NRVC, plasma from MI patients and monoclonal anti-apoA-1 IgG induced an aldosterone and dose-dependent positive chronotropic effect, abrogated by apoA-1 and therapeutic immunoglobulin (IVIG) pre-incubation.


CONCLUSIONS
In MI patients, anti-apoA-1 IgG is independently associated with MACE at 1-year, interfering with a currently unknown aldosterone-dependent RHR determinant. Knowing whether anti-apoA-1 IgG assessment could be of interest to identify an MI patient subset susceptible to benefit from apoA-1/IVIG therapy remains to be demonstrated.
Vuilleumier
Nicolas
N
Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva 14, Switzerland. nicolas.vuilleumier@hcuge.ch
Rossier
Michel F
MF
Pagano
Sabrina
S
Python
Magaly
M
Charbonney
Emmanuel
E
Nkoulou
René
R
James
Richard
R
Reber
Guido
G
Mach
François
F
Roux-Lombard
Pascale
P
D054058:Acute Coronary Syndrome / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016632:Apolipoprotein A-I / Q000276:immunology*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D004306:Dose-Response Relationship, Immunologic; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006339:Heart Rate / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D032383:Myocytes, Cardiac / Q000276:immunology; D011379:Prognosis; D011446:Prospective Studies; D051381:Rats; D017208:Rats, Wistar; D012016:Reference Values; D015203:Reproducibility of Results; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome
D016632:Apolipoprotein A-I; D015415:Biomarkers; D007074:Immunoglobulin G