Dynamics of serum-induced endothelial cell apoptosis in patients with myocardial infarction

Background In patients with ST-segment elevation myocardial infarction (STEMI) reperfused with primary coronary intervention (PCI), the dynamics of endothelial cell (EC) viability, apoptosis and necrosis and its relationship with the structural consequences on the left ventricle have not been addressed so far. Design In 20 STEMI patients, we incubated human umbilical vein endothelial cells (HUVECs) with serum drawn before reperfusion and subsequently afterwards (24, 96 h, 30 days). Viability, apoptosis and necrosis percentages were evaluated by flow cytometry. Values were compared with 12 age- and sex-matched control subjects with normal coronary arteries. Cardiac magnetic resonance (CMR) was performed during the first week after infarction. Results Serum from STEMI patients induced a progressive loss of EC viability, with a nadir of 67.7 +/- 10.2% at 96 h (baseline: 75 +/- 6% and controls: 80.2 +/- 3.9%, P<0.001 in both cases). This is due to an increase in apoptosis that peaked at 96 h after reperfusion (15.2 +/- 7.1% vs. 11 +/- 6 at baseline and 5.8 +/- 1.6% in controls, P<0.001 in both cases). However, no significant dynamic changes in EC necrosis were detected. Extensive myocardial oedema (> 30%, median of left ventricular mass) was the only CMR variable significantly associated with a higher percentage of EC apoptosis at 96 h (extensive vs. nonextensive oedema: 18.3 +/- 6.8% vs. 12.1 +/- 6.3%, P < 0.05). Conclusions Dynamic changes in EC viability occur in the setting of STEMI patients reperfused with PCI, these changes peak late after reperfusion, they are mainly the result of an increase of apoptosis and are associated with the presence of extensive myocardial oedema.