Abstract 2610: Plasma Level of Soluble Fms-like Tyrosine Kinase 1 (sFlt-1) as a Predictive Marker of Acute Severe Heart Failure in Patients with Acute Myocardial Infarction
BACKGROUND: We previously reported that acute cardiac over-expression of placental growth factor (PlGF) contributed to the improvement of cardiac function in patients with acute myocardial infarction (MI). Moreover, we recently observed that administration of PlGF improves ventricular function and survival in acute MI in mice. Fms-like tyrosine kinase 1 (Flt-1) is a specific receptor of PlGF, and its soluble form (sFlt-1) is known as a natural antagonist of PlGF and vascular endothelial growth factor (VEGF). The increment of plasma levels of sFlt-1 in patients with acute MI has already been reported, but its dynamics and clinical significance were still unknown.
OBJECTIVES: Our aim is to investigate the clinical siginificance of sFlt-1 during acute MI.
METHODS: We enrolled 198 patients with acute MI. Arterial blood sampling was serially performed on admission (before emergent catheterization), 14th hospital day, and 6 months after MI. Plasma levels of sFlt-1 were measured by ELISA.
Plasma levels of sFlt-1 on admission in arterial blood were significantly elevated in acute MI patients compared with controls (509 +/- 17 vs. 357 +/- 13 pg/ml, P<0.01), and decreased to the control level at 14th day after MI.
In acute MI patients, plasma levels of sFlt-1 on admission were significantly higher among patients who developed acute severe heart failure ( i.e. treated with mechanical circulatory support devices, including IABP and PCPS), than those with stable hemodynamics (611 +/- 56 vs. 493 +/- 26 pg/ml, P<0.05). Moreover, plasma levels of sFlt-1 on admission were positively correlated to the duration of hospitalization (r=0.17, p<0.05).
Univariate analysis showed that the hemodynamic instability was predicted by patient age and plasma level of sFlt-1 on admission.
Brain natriuretic peptide and estimated creatinine clearance were not predictors in this analysis.
CONCLUSIONS: Plasma levels of sFlt-1 were increased in patients with acute MI, and elevated plasma sFlt-1 after acute MI might impair patients’ hemodynamics probably by interfering the beneficial effects of PlGF on damaged myocardium. Plasma level of sFlt-1 on admission seems to be a useful biomarker of developing severe heart failure after MI.