Prognostic value of activated toll-like receptor-4 in monocytes following acute myocardial infarction.

This study tested the hypothesis that activated toll-like receptor-4 (TLR-4) is closely related to combined major adverse clinical outcomes (MACO) [defined as advanced Killip score (>/= 3), overt congestive heart failure (CHF) (New York Heart Association functional class >/= 2) or 30-day death] in patients with ST-segment elevation (ST-se) acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). We conducted a prospective cohort study in 43 consecutive patients with ST-se AMI of onset < 12 hours who were undergoing primary PCI. Blood samples for TLR-4 and serum level of tumor necrosis factor-alpha (TNF-alpha) were collected from 43 patients at 24 hours after AMI and from 20 normal outpatients. The experimental results revealed significantly higher baseline levels of TLR-4, TNF-alpha and white blood cell (WBC) count in the study patients than in normal control subjects (all P < 0.0001). Additionally, baseline levels of TLR-4, TNF-alpha , creatinine, peak level of CK-MB, and multiple vessel disease were significantly higher, whereas left ventricular performance was notably lower in patients (n = 18) with occurrence of MACO than in patients (n = 25) without occurrence of MACO (all P < 0.05). Furthermore, the level of lipopolysaccharide (LPS)-stimulated LTR-4 was significantly increased in MACO patients than in those without MACO (P < 0.0001). Moreover, LPS-stimulated TLR-4 was the most independent predictor of 30-day MACO (P < 0.01). In patients with ST-se AMI, activated TLR-4 is independently predictive of 30-day MACO.

Sheu JJ, Chang LT, Chiang CH, Youssef AA, Wu CJ, Lee FY, Yip HK.

Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine.