Vibeke Nordmo Ritschel’s research indicates that the interleukin-6 receptor could be a therapeutic target in patients with acute ST-elevation myocardial infarction.

MAIN RESULTS:

1. Markers of inflammation and thrombin generation are linked to cardiac dysfunction following an acute myocardial infarction.
2. The soluble receptor for interleukin-6 is associated with worse outcome following STEMI.
3. Connective tissue growth factor is not linked to prognosis after STEMI

THESIS DEFENCE:

Thesis: Markers of inflammation and haemostatis: Associations with myocardial injury, adverse remodelling, and future clinical events in patients with ST-elevation myocardial infarction
Candidate: Vibeke Nordmo Ritschel
Time: November 16, 2018 at 13:15
Place: Oslo University Hospital, Ullevål, Building 36: Auditorium
Link to university website

SUMMARY:

Ritschel and co-workers have analyzed blood samples from more than 1000 patients hospitalized with an acute ST-elevation myocardial infarction between 2007 and 2011. All the patients received percutaneous coronary intervention, and the blood samples were collected the morning after.

(1/2) The inflammatory markers interleukin-6 and C-reactive protein are linked to markers of myocardial injury, namely troponin T and NT-proBNP, following an acute myocardial infarction. Also markers of thrombin generation – prothrombin fragment 1+2 and D-dimer – are independently associated with higher troponin T. The levels of D-dimer associate with NT-proBNP, as well.

The researchers also measured left ventricular systolic function with cardiac ultrasound within three months of the event in many of the patients. Interleukin-6, C-reactive protein and D-dimer showed independent associations with left ventricular dysfunction.

(3) The STEMI patients with the highest levels of soluble interleukin-6-receptor had increased combined risk of early death, a new myocardial infarction, stroke, heart failure hospitalization or acute revascularization.

The study followed 989 patients until 2014, and 200 of them experienced at least one adverse event during follow-up. 82 died, and the levels of soluble interleukin-6 receptor were also independently associated with increased mortality.

(4) The levels of connective tissue growth factor (CCN2) during an acute myocardial infarction have no impact on prognosis, infarct size or left ventricular function. This study includes blood samples and follow-up data for the same patients as the other articles, as well as blood samples, cardiac-MRI and follow-up data for 258 STEMI patients from another cohort.

REFERENCES:

(1) Ritschel, V. N., Seljeflot, I., Arnesen, H., Halvorsen, S., Weiss, T., Eritsland, J., & Andersen, G. Ø. (2014). IL-6 signalling in patients with acute ST-elevation myocardial infarction. Results in immunology, 4, 8-13.

(2) Hansen, C. H., Ritschel, V., Halvorsen, S., Andersen, G. Ø., Bjørnerheim, R., Eritsland, J., Arnesen, H. & Seljeflot, I. (2015). Markers of thrombin generation are associated with myocardial necrosis and left ventricular impairment in patients with ST-elevation myocardial infarction. Thrombosis journal, 13(1), 31.

(3) Ritschel, V. N., Seljeflot, I., Arnesen, H., Halvorsen, S., Eritsland, J., Fagerland, M. W., & Andersen, G. Ø. (2016). Circulating levels of IL‐6 receptor and gp130 and long‐term clinical outcomes in ST‐elevation myocardial infarction. Journal of the American Heart Association, 5(6), e003014.

(4) Ritschel, V., Shetelig, C., Seljeflot, I., Limalanathan, S., Hoffmann, P., Halvorsen, S., Arnesen, H., Eritsland, J., & Andersen, G. Ø. (2017). Evaluation of circulating levels of CCN2/connective tissue growth factor in patients with ST-elevation myocardial infarction. Scientific reports, 7(1), 11945.