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

Hans Kossmann, Christoph Rischpler, Franziska Hanus, Stephan G Nekolla, Karl P Kunze, Katharina Götze, Alexander Goedel, Hendrik Sager, Adnan Kastrati, Daniel Sinnecker, Christian Kupatt, Tareq Ibrahim, Markus Schwaiger, Karl-Ludwig Laugwitz, Ralf J Dirschinger
International Journal of Cardiology 2019 July 15, 287: 7-12
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 18 F-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 18 F-FDG uptake, monocyte platelet aggregates (MPA), and P2Y12 inhibition. In detail, patients with high MPA percentages of CD14high CD16+ and CD14low CD16+ monocytes had significantly higher local 18 F-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.


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