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

被引：344

作者：

Abbate, Antonio ^{[1
]}

Kontos, Michael C. ^{[1
]}

Grizzard, John D. ^{[1
]}

Biondi-Zoccai, Giuseppe G. L. ^{[2
]}

Van Tassell, Benjamin W. ^{[1
]}

Robati, Roshanak ^{[1
]}

Roach, Lenore M. ^{[1
]}

Arena, Ross A. ^{[1
]}

Roberts, Charlotte S. ^{[1
]}

Varma, Amit ^{[1
]}

Gelwix, Christopher C. ^{[1
]}

Salloum, Fadi N. ^{[1
]}

Hastillo, Andrea ^{[1
]}

Dinarello, Charles A. ^{[3
]}

Vetrovec, George W. ^{[1
]}

机构：

[1] Virginia Commonwealth Univ, VCU Pauley Heart Ctr, Richmond, VA 23284 USA

[2] Univ Turin, Div Cardiol, Turin, Italy

[3] Univ Colorado, Dept Internal Med, Aurora, CO USA

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2010年 / 105卷 / 10期

关键词：

RECEPTOR ANTAGONIST; INHIBITION;

D O I：

10.1016/j.amjcard.2009.12.059

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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)

引用

页码：1371 / 1377

页数：7

共 27 条

[1] Anakinra, a recombinant human interleukin-1 receptor antagonist, inhibits apoptosis in experimental acute myocardial infarction [J].