Monocyte-platelet aggregates affect local inflammation in patients with acute myocardial infarction

Int J Cardiol. 2019 Jul 15;287:7-12. doi: 10.1016/j.ijcard.2019.04.009. Epub 2019 Apr 8.

Abstract

The local inflammatory response following acute myocardial infarction (AMI) is increasingly being recognized as a central factor determining infarct healing. Myocardial inflammation can be visualized in patients using fasting 18F-FDG PET/MRI. Although this novel biosignal correlates with long-term functional outcome, the corresponding cellular substrate is not well understood. Here we present a retrospective analysis of 29 patients with AMI who underwent revascularization, suggesting a connection between post infarction myocardial fasting 18F-FDG uptake, monocyte platelet aggregates (MPA), and P2Y12 inhibition. In detail, patients with high MPA percentages of CD14highCD16+ and CD14lowCD16+ monocytes had significantly higher local 18F-FDG uptake (SUVmean) in the infarcted myocardium than patients with low MPA (p < 0.05). Furthermore, there was an association of high MPA percentage in all monocyte subpopulations with deteriorating ΔLV-EF after 6 months (p < 0.01), which was confirmed in an extended analysis with additional 29 patients without PET/MRI data available. In this analysis, administration of Ticagrelor was associated with lower MPA percentage of CD14high monocyte subpopulations than Clopidogrel (p < 0.01) or Prasugrel (p < 0.05). Taken together, the findings from this analysis suggest that platelet aggregability may affect monocyte extravasation into the infarcted myocardium and influence long-term functional outcome. P2Y12 inhibition may intervene in this pathophysiologic process. Prospective studies are needed to further examine this important relationship.

Keywords: (18)F-FDG PET-MRI; Inflammation; Monocyte-platelet aggregates; Myocardial infarction; P2Y(12) inhibitor; Remodeling.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Flow Cytometry
  • Follow-Up Studies
  • Humans
  • Inflammation / blood*
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Monocytes / physiology*
  • Myocardial Infarction / blood*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy
  • Platelet Aggregation / physiology*
  • Platelet Function Tests
  • Positron-Emission Tomography
  • Prognosis
  • Purinergic P2Y Receptor Antagonists / therapeutic use
  • ROC Curve
  • Retrospective Studies
  • Ticagrelor / therapeutic use*
  • Ventricular Function, Left / physiology
  • Ventricular Remodeling / physiology*

Substances

  • Purinergic P2Y Receptor Antagonists
  • Ticagrelor