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Background  Macrophage migration inhibitory factor ( MIF ) is a key regulator of inflammatory responses, including in the heart. Plasma  MIF  is elevated early in the course of acute myocardial infarction. In this study, we hypothesized that plasma  MIF  may also be increased in acute myocardial ischemia.    Methods and Results  Patients undergoing cardiac stress test (stress nuclear myocardial perfusion scan or stress echocardiography) were recruited. Twenty‐two patients had a stress test indicative of myocardial ischemia and were compared with 62 patients who had a negative stress test. Plasma  MIF  was measured by ELISA before and after the stress test.  MIF  was also measured in patients with peripheral arterial occlusive disease before and after exercise causing claudication. Gene and protein expression of  MIF  was measured in mouse cardiac and skeletal muscle tissue by real‐time polymerase chain reaction and western blot, respectively. Plasma  MIF  was elevated at 5 and 15 minutes after stress (relative to before stress) in patients with a positive test, compared with those with a negative test. In contrast, high‐sensitivity troponin T and C‐reactive protein were not altered after stress in either group.  MIF  was not altered after exercise in  PAOD  patients, despite the occurrence of claudication, suggesting that plasma  MIF  is not a marker for skeletal muscle ischemia. This may be explained by a lower gene and protein expression of  MIF  in skeletal muscle than the heart.    Conclusions  Our results suggest that plasma  MIF  is an early marker for acute myocardial ischemia.

Plasma Macrophage Migration Inhibitor Factor Is Elevated in Response to Myocardial Ischemia