Expression of activation antigens on lymphocyte surface and circulating platelet-leukocyte aggregates in ischaemic heart disease.

Background: Data from literature documented the role of the activation of circulating T lymphocytes and increased leukocyte adhesion to blood platelets in the destabilisation of an atheromatous plaque and progression of ischaemic heart disease to acute coronary syndrome.

Aim: To assess whether there is an increased proportion of activated T lymphocytes and platelet-leukocyte aggregates (PLA) in the circulating blood in patients with myocardial infarction or with stable angina, and to examine whether these changes are related to the progression of clinical symptoms or coronary angiography results.

Methods: The study group consisted of 36 patients with ST-segment elevation acute myocardial infarction (STEMI), confirmed by elevated troponin T level (36 patients, 26 males, 10 females, mean age 61.8 years, range 42-78 years), 30 patients with stable angina and single-vessel disease (24 males, 6 females, mean age 58.8 years, range 43-69 years), and 20 control healthy age and gender-matched subjects. Lymphocyte activation was evaluated by the assessment of T lymphocytes CD3+ /CD69+, CD3+/HLA-DR+ and CD4+/CD154+. The PLA assessment, including platelet-granulocyte aggregates (PGA), platelet-monocyte aggregates (PMA) and platelet-lymphocyte aggregates (PlymphA) was based on the measurement of the proportion of CD45+/CD41a+ cells with the use of flow cytometry.

Results: The proportion of T lymphocytes CD3+/HLA-DR+, CD3+/CD69+ and CD4+/CD154 was significantly higher in patients with STEMI than in controls, and T lymphocytes CD3+/CD69+ - significantly higher in STEMI group than in both patients with angina or controls. There was no significant relationship between the proportion of activated lymphocytes and duration of anginal pain, troponin T concentration or the number of coronary vessels with critical stenosis. The proportion of PGA, PMA and PlymphA was significantly greater in STEMI patients than in patients with angina or controls. There was a significant positive correlation between the proportion of PLA and PMA, and the duration of anginal pain. Patients with stable angina had a significantly higher proportion of T lymphocytes CD3+/HLA-DR+ compared with controls.

Conclusions: Circulating T lymphocyte activation is present in ischaemic heart disease. This phenomenon is more pronounced in patients with acute MI than in those with stable angina, and is not related to the degree of cardiac injury. An increased formation of platelet-leukocyte aggregates is also present in patients with acute MI.