title: HMGB1 as a predictor of infarct transmurality and functional recovery in patients with myocardial infarction.
abstract: OBJECTIVE
  High-mobility group box 1 (HMGB1) protein is an innate danger signal for the initiation of host defence and tissue repair. The aim of this study was to analyse serum HMGB1 concentration and its correlation with infarct transmurality and functional recovery in patients with ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  We prospectively examined patients with first-time STEMI (n = 46) or NSTEMI (n = 49), treated according to current guidelines. Contrast-enhanced cardiac magnetic resonance imaging was performed 2-4 days after infarction for the estimation of infarct transmurality and was repeated after 6 months for the estimation of residual left ventricular function. HMGB1 was measured 2-4 days after infarction.
  
  
  RESULTS
  High-mobility group box 1 concentration was related to infarct size and to residual ejection fraction in patients with STEMI (r(2) = 0.81 and r(2) =0.40, respectively, P < 0.001 for both) and NSTEMI (r(2) = 0.74 and r(2) = 0.25, respectively, P < 0.001 for both). Receiver operating characteristic (ROC) curve-derived cut-off values of 6.2 and 5.9 ng mL(-1) for patients with STEMI and NSTEMI, respectively, were predictive of infarct transmurality greater than 75% (STEMI: area under the curve (AUC) = 0.93, standard error (SE) = 0.04, 95% confidence interval (CI) = 0.81-0.98; NSTEMI: AUC = 0.96, SE = 0.04, 95% CI = 0.86-0.99). HMGB1 cut-off values of 7.2 and 6.4 ng mL(-1) for patients with STEMI and NSTEMI, respectively, were predictive of residual ejection fraction 6 months after myocardial infarction (MI) (STEMI: AUC = 0.81, SE = 0.07, 95% CI = 0.66-0.91; NSTEMI: AUC = 0.81, SE = 0.09, 95% CI = 0.68-0.91).
  
  
  CONCLUSIONS
  High-mobility group box 1 serum levels represent a highly valuable surrogate marker for infarct transmurality and for the prediction of residual left ventricular function after MI.
authors.affiliation: Department of Cardiology, University of Heidelberg, Heidelberg, Germany. martin.andrassy@med.uni-heidelberg.de
authors.forename: M
authors.initials: M
authors.lastname: Andrassy
authors.forename: H C
authors.initials: HC
authors.lastname: Volz
authors.forename: N
authors.initials: N
authors.lastname: Riedle
authors.forename: G
authors.initials: G
authors.lastname: Gitsioudis
authors.forename: C
authors.initials: C
authors.lastname: Seidel
authors.forename: D
authors.initials: D
authors.lastname: Laohachewin
authors.forename: A R
authors.initials: AR
authors.lastname: Zankl
authors.forename: Z
authors.initials: Z
authors.lastname: Kaya
authors.forename: A
authors.initials: A
authors.lastname: Bierhaus
authors.forename: E
authors.initials: E
authors.lastname: Giannitsis
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.forename: G
authors.initials: G
authors.lastname: Korosoglou
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media; D003402:Creatine Kinase / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D024243:HMGB1 Protein / Q000097:blood*; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000503:physiopathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000473:pathology* / Q000503:physiopathology*; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013997:Time Factors; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D024243:HMGB1 Protein; D020107:Troponin T; D003402:Creatine Kinase