title: Angiopoietin-like 4 serum levels on admission for acute myocardial infarction are associated with no-reflow.
abstract: BACKGROUND
  No-reflow in ST-segment elevation acute myocardial infarction (STEMI) is associated with a poor clinical prognosis. Its pathophysiological mechanisms are not fully elucidated yet but enhanced vascular permeability plays a key role in this phenomenon. Angiopoietin-like 4 (ANGPTL4) has been implicated in vascular permeability in experimental models of acute myocardial infarction (AMI). We therefore sought to investigate whether baseline ANGPTL4 serum levels are associated with no-reflow after primary percutaneous coronary intervention (PPCI).
  
  
  METHODS
  We studied a group of 41 patients presenting with a first STEMI within 12h of onset of symptoms and who underwent successful PPCI. Blood samples were obtained from all patients on admission before the start of the procedure, for ANGPTL4 level measurement. No-reflow was assessed by cardiac magnetic resonance imaging (MRI), the reference method.
  
  
  RESULTS
  MRI-detected no-reflow was observed in 20 patients (48.8%). Variables independently associated with no-reflow on multivariate logistic regression analysis were: lower ANGPTL4 serum levels (odds ratio 0.82, 95% CI 0.70-0.98, P=0.02), higher troponin T peak (odds ratio 1.03, 95% CI 1.00-1.05, P=0.03), higher incidence of left anterior descending coronary artery (LAD) as culprit artery (odds ratio 14.61, 95% CI 1.24-172.49, P=0.03), and higher C-reactive protein levels (odds ratio 1.18, 95% CI 1.00-1.39, P=0.05).
  
  
  CONCLUSIONS
  ANGPTL4 serum levels predict MRI-detected no-reflow after successful PPCI in STEMI patients. Given the recently demonstrated therapeutic role of ANGPTL4 in diminishing no-reflow and limiting infarct size in pre-clinical animal models, these findings in humans may open up new possibilities in the field of research.
authors: Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), 11, place Marcelin Berthelot, Paris F-75005, France; CNRS UMR 7241, Paris F-75005, France; INSERM U 1050, Paris F-75005, France; Service de Cardiologie, Hôpital Bichat, AP-HP, F-75018, France; DHU FIRE, Université Paris Diderot, France.
authors: Claire
authors: C
authors: Bouleti
authors: Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), 11, place Marcelin Berthelot, Paris F-75005, France; CNRS UMR 7241, Paris F-75005, France; INSERM U 1050, Paris F-75005, France.
authors: Thomas
authors: T
authors: Mathivet
authors: Plateforme d'Imagerie du petit animal, Service de Radiologie, Hôpital Bichat, AP-HP, F-75018, France.
authors: Jean-Michel
authors: JM
authors: Serfaty
authors: Institut de cardiologie (AP-HP), ACTION study group, France; INSERM U937, Pitié-Salpêtrière University Hospital, Université Paris 6, France.
authors: Nicolas
authors: N
authors: Vignolles
authors: Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), 11, place Marcelin Berthelot, Paris F-75005, France; CNRS UMR 7241, Paris F-75005, France; INSERM U 1050, Paris F-75005, France.
authors: Elodie
authors: E
authors: Berland
authors: Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), 11, place Marcelin Berthelot, Paris F-75005, France; CNRS UMR 7241, Paris F-75005, France; INSERM U 1050, Paris F-75005, France; Service de Cardiologie, Hôpital Bichat, AP-HP, F-75018, France; DHU FIRE, Université Paris Diderot, France.
authors: Catherine
authors: C
authors: Monnot
authors: Service de radiologie, Hôpital La Pitié-salpêtrière, AP-HP, Paris, France.
authors: Philippe
authors: P
authors: Cluzel
authors: Service de Cardiologie, Hôpital Bichat, AP-HP, F-75018, France; DHU FIRE, Université Paris Diderot, France.
authors: Philippe Gabriel
authors: PG
authors: Steg
authors: Institut de cardiologie (AP-HP), ACTION study group, France; INSERM U937, Pitié-Salpêtrière University Hospital, Université Paris 6, France.
authors: Gilles
authors: G
authors: Montalescot
authors: Collège de France, Centre for Interdisciplinary Research in Biology (CIRB), 11, place Marcelin Berthelot, Paris F-75005, France; CNRS UMR 7241, Paris F-75005, France; INSERM U 1050, Paris F-75005, France; Equipe labellisée Ligue contre le Cancer, France; Service de Pathologie, Hôpital Saint-Louis, AP-HP, F-75010 Paris, France. Electronic address: stephane.germain@college-de-france.fr.
authors: Stéphane
authors: S
authors: Germain
mesh_terms: D000368:Aged; D000075803:Angiopoietin-Like Protein 4; D042682:Angiopoietins / Q000097:blood*; D000818:Animals; D002097:C-Reactive Protein / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D051379:Mice; D018345:Mice, Knockout; D008875:Middle Aged; D023421:Models, Animal; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D054318:No-Reflow Phenomenon / Q000097:blood* / Q000503:physiopathology; D016017:Odds Ratio; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D020107:Troponin T / Q000097:blood
chemical_list: C474772:ANGPTL4 protein, human; D000075803:Angiopoietin-Like Protein 4; D042682:Angiopoietins; D020107:Troponin T; D002097:C-Reactive Protein
keywords: Acute myocardial infarction; Endothelium; No-reflow; Vascular biology