C4d Deposition Reveals Myocardial Infarction After Cardiac Arrest -Experimental Study

Abstract

Background. The diagnosis of regional myocardial infarction (MI) after cardiac arrest and ischemia-reperfusion injury (IRI) is a major clinical challenge. Objectives. We evaluated in a rat cardiac transplantation model whether IRI alone or with MI would induce complement C4d deposition. Material and Methods. Isogenic heterotopic cardiac transplantation was performed in 16 Fischer 344 rats to induce IRI, of which 9 rats also underwent ligation of the left anterior coronary artery (LAD) of the heart to yield MI. Histology and qRT-PCR for endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and transforming growth factor β (TGFβ) were performed after cessation of heart beat. C4d was evaluated by immunohistochemistry. Results. Myocardial inflammation and C4d deposition was increased in grafts with IRI+MI as compared with IRI (0.71 vs. 0.14, PSU, respectively, p < 0.04 and 80.13 vs. 20.29, PSU, respectively, p < 0.02). The expression of eNOS decreased in grafts with IRI + MI as compared with IRI (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that IRI + MI was associated with C4d deposition (AUC 0.837; S.E. 0.116; p = 0.035; 95% C.I. 0.610-1.000). Conclusions. Increased C4d deposition may be amenable to identify early MI after cardiac arrest. Early treatment aimed towards complement activation may provide a novel means for induced MI after cardiac arrest (Adv Clin Exp Med 2015, 24, 3, 393-399).

Evaluation of expression levels and mechanism of complement activation

“…The diagnostic criteria of acute myocardial infarction were as follows: CT angiography showed that dissection diaphragm divided aorta into true lumen and false lumen ( 3 ). The diagnostic criteria of coronary artery stenosis were the pathological expansion of abdominal aorta exceeding 50% of normal blood vessel diameter ( 12 ). All the patients underwent preoperative examination including ultrasonic cardiogram and signed informed consent after postoperative pathology identification.…”