DEPT. OF CARDIILOGY, SHAHEED RAJAEI CARDIOVASCULAR MEDICAL CENTER, TEHRAN, IRAN
Objectives- The aim of this study was to determine the significance of peripheral monocytosis in the early progression to congestive heart failure (CHF).
Background- Peripheral leukocytosis and monocytosis occur after AMI, especially at the 3rd day, reflecting infiltration of monocytes and macrophages into the necrotic myocardium.
The relationship between peak 3rd day monocytosis with the progression to AMI complications was established earlier. However, the prognostic significance of the 1st day monocytosis after AMI remains to be determined.
Methods- From a total of 165 patients with first Q-wave AMI, studied after admission from 2002 to 2003, 101 patients were selected. The CBC HI test at the first 24 hrs, echocardiographic study and physical exam in the first 4 days of the onset of AMI were evaluated. The association between peripheral monocytosis and progression to CHF after AMI was assessed.
Results- Of all the patients (101 cases), 40 (39.4 percent) patients had monocytosis equal or more than 620. Forty-seven (46.5 percent) patients were CHF-positive. The patients with CHF had 13085±4095/mm total WBC count, whereas the others had 10428±3256/mm (p<0.001). PMN count in the CHF and normal groups was 10927±4205/mmand 8299±3137/mm, respectively (p<0.01). The mean of monocyte count in the CHF-positive group was 740.8±334/mmin comparison with that in the CHF-negative group, 516±26/mm(p=0.0001).The mean of the EF in the CHF-positive patients was 33.8±10.3 percent versus the 40.7±7.7 percent in the CHF-negative patients (P=0.0001).
Conclusion- Peripheral monocytosis in the first 24 hrs after AMI is associated with CHF, suggesting a possible role of monocytosis as the bedside marker of CHF evolution in the hospitalization period. Clinical markers that can predict which patients are prone to develop adverse LV structural remodeling and post-MI complications, therefore, would be very useful in the prevention of them.