Anti-Inflammatory Strategies for Ventricular Remodeling Following ST-Segment Elevation Acute Myocardial Infarction

Abstract

Acute myocardial infarction (AMI) leads to molecular, structural, geometric, and functional changes in the heart in a process known as ventricular remodeling. An intense organized inflammatory response is triggered after myocardial ischemia and necrosis and involves all components of the innate immunity, affecting both cardiomyocytes and noncardiomyocyte cells. Inflammation is triggered by tissue injury; it mediates wound healing and scar formation and affects ventricular remodeling. Many therapeutic attempts aimed at reducing inflammation in AMI during the past 3 decades presented issues of impaired healing or increased risk of cardiac rupture or failed to show any additional benefit in addition to standard therapies. More recent strategies aimed at selectively blocking one of the key factors upstream rather than globally suppressing the response downstream have shown some promising results in pilot trials. We herein review the pathophysiological mechanisms of inflammation and ventricular remodeling after AMI and the results of clinical trials with anti-inflammatory strategies.

Dietary Docosahexaenoic Acid Reduces Oscillatory Wall Shear Stress, Atherosclerosis, and Hypertension, Most Likely Mediated via an IL‐1–Mediated Mechanism

“…Contemporary primary and secondary therapies for cardiovascular disease prevent the progression of atherosclerosis and stabilize the plaque, providing significant clinical benefit42; however, not all patients respond to risk factor–modifying therapy, especially patients with hypertension 43, 44, 45. The Ω‐3 fatty acids, particularly DHA (a major type of n3FA in fish oil) and α‐linolenic acid (ALA; the most common land‐based type of n3FAs), have been shown to play an important role in preventive medicine 46, 47.…”

Leukocyte Activity in Patients with ST-Segment Elevation Acute Myocardial Infarction Treated with Anakinra

“…Leukocyte activity ex vivo. (A, B) IL-6 production from leukocytes in unstimulated conditions expressed as absolute IL-6 amounts or normalized per 1,000 leukocytes per mm 3 , respectively. (C, D) IL-6 production in response to Escherichia coli lipopolysaccharide (LPS) 1,000 ng/mL expressed as absolute IL-6 amounts or normalized per 1,000 leukocytes per mm 3 , respectively.…”

“…Adverse cardiac remodeling after an acute myocardial infarction (AMI) remains one of the most important determinants of survival, despite the striking improvements made in the diagnosis and treatment of AMI in recent years (2). Over recent years, a large amount of evidence stressed the importance of the inflammatory response in adverse cardiac remodeling after AMI (3,4). More specifically, specific inflammation mediators are emerging as novel therapeutic targets (3,4).…”

“…Over recent years, a large amount of evidence stressed the importance of the inflammatory response in adverse cardiac remodeling after AMI (3,4). More specifically, specific inflammation mediators are emerging as novel therapeutic targets (3,4).…”

Effects of Therapeutic Lifestyle Change Diet and Q10 Plus L-Carnitine Supplementation on Inflammatory Biomarkers of In-Stent Restenosis, Lipid Profile, and Left Ventricular Ejection Fraction in Myocardial Infarction: A Randomized Clinical Trial

“…Previous studies have shown that 47% of MI patients had hyperlipidemia (4). Additionally, an extreme inflammatory response was detected post MI, and the improvement of inflammation had an important role in ventricular remodeling and promotion of left ventricular ejection fraction (LVEF) (5). In addition, In-Stent Restenosis (ISR) is one of the important complications after PCI, which depends on CV risk factors (6,7), such as inflammation (8), hyperlipidemia (9), and lesion features (10).…”