Right ventricular remodeling in AMI.

<p>Panel A shows cross-section of the left and right ventricles (apical section) stained with Masson's trichrome to identify fibrous scar in the infarct. Involvement of a large area of the anterolateral left ventricle free wall (arrows) and sparing of the interventricular septum and right ventricle (*) is evident. Panel B shows an echocardiographic image (short axis view) of the left and right ventricles (mid-ventricular section) in a mouse 7 days after permanent coronary artery ligation. An aneurysm of the anterolateral left ventricular free wall is noted (arrows). The interventricular septum is indicated by (*) and the right ventricular cavity is indicated by (•). Panel C shows a M-mode recording on the tricuspidal annulus plane systolic excursion (TAPSE) obtained from a 4-chamber apical view. Panels D and E show changes in right ventricular fractional area change (RVFAC) and tricuspidal annulus plane systolic excursion (TAPSE) over time in mice with AMI due to permanent coronary ligation and mice with sham operation (N = 10 per group). Panel F shows right ventricular systolic pressure (RVSP) in mice with AMI due to permanent coronary ligation and mice with sham operation 7 days after surgery with no differences noted between the groups (N = 5 per group). Panel G shows the lack of correlation between RVSP and RVFAC in mice with AMI due to permanent coronary ligation and mice with sham operation 7 days after surgery. Panels H and I show data deriving from the model of reperfused AMI as it compares with the non-reperfused AMI: reperfused AMI had a smaller decline in LV systolic function (LVFAC, panel H) yet a similar decline in RV systolic function (RVFAC, panel I).</p

Experimental AMI in the mouse.

<p>Footnote for <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0018102#pone-0018102-t001" target="_blank">Table 1</a>.</p><p>*<b>P<0.05 vs baseline.</b></p><p><b>Abbreviations:</b> LV- Left ventricular; LVEDD – Left Ventricular End-diastolic Diameter; LVESD – Left Ventricular End-systolic Diameter; LVEF – Left Ventricular Ejection Fraction; LVFAC – Left Ventricular Fractional Area Change; LVFS – Left ventricular fractional shortening; LVEDP – Left ventricular end diastolic pressure; RV- Right ventricular; RVFAC – Right Ventricular Fractional Area Change; RVSP – Right ventricular systolic pressure; TAPSE – Tricuspidal Annulus Plane Systolic Excursion.</p

Interleukin-1 Blockade With Anakinra to Prevent Adverse Cardiac Remodeling After Acute Myocardial Infarction (Virginia Commonwealth University Anakinra Remodeling Trial [VCU-ART] Pilot Study)

Acute myocardial infarction (AMI) initiates an intense inflammatory response in which interleukin-1 (IL-1) plays a central role. The IL-1 receptor antagonist is a naturally occurring antagonist, and anakinra is the recombinant form used to treat inflammatory diseases. The aim of the present pilot study was to test the safety and effects of IL-1 blockade with anakinra on left ventricular (LV) remodeling after AMI. Ten patients with ST-segment elevation AMI were randomized to either anakinra 100 mg/day subcutaneously for 14 days or placebo in a double-blind fashion. Two cardiac magnetic resonance (CMR) imaging and echocardiographic studies were performed during a 10- to 14-week period. The primary end point was the difference in the interval change in the LV end-systolic volume index (LVESVi) between the 2 groups on CMR imaging. The secondary end points included differences in the interval changes in the LV end-diastolic volume index, and C-reactive protein levels. A +2.0 ml/m(2) median increase (interquartile range +1.0, +11.5) in the LVESVi on CMR imaging was seen in the placebo group and a -3.2 ml/m(2) median decrease (interquartile range -4.5, -1.6) was seen in the anakinra group (p = 0.033). The median difference was 5.2 ml/m(2). On echocardiography, the median difference in the LVESVi change was 13.4 ml/m(2) (p = 0.006). Similar differences were observed in the LV end-diastolic volume index on CMR imaging (7.6 ml/m(2), p = 0.033) and echocardiography (9.4 ml/m(2), p = 0.008). The change in C-reactive protein levels between admission and 72 hours after admission correlated with the change in the LVESVi (R = +0.71, p = 0.022). In conclusion, in the present pilot study of patients with ST-segment elevation AM I, IL-1 blockade with anakinra was safe and favorably affected by LV remodeling. If confirmed in larger trials, IL-1 blockade might represent a novel therapeutic strategy to prevent heart failure after AMI. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1371-1377