Tumor Necrosis Factor-α Predicts Response to Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure

被引:20
作者
Rordorf, Roberto [1 ]
Savastano, Simone [1 ]
Sanzo, Antonio [1 ]
Spazzolini, Carla [3 ,4 ]
De Amici, Mara [2 ]
Camporotondo, Rita [1 ]
Ghio, Stefano [1 ]
Vicentini, Alessandro [1 ]
Petracci, Barbara [1 ]
De Regibus, Valentina [1 ]
Taravelli, Erika [1 ]
Landolina, Maurizio [1 ]
Schwartz, Peter J. [4 ]
机构
[1] IRCCS Fdn Policlin S Matteo, Dept Cardiol, I-27100 Pavia, Italy
[2] IRCCS Fdn Policlin S Matteo, Dept Pediat, I-27100 Pavia, Italy
[3] Univ Pavia, Dept Mol Med, Cardiol Sect, I-27100 Pavia, Italy
[4] IRCCS Ist Auxol Italiano, Ctr Cardiac Arrhythmias Genet Origin, Milan, Italy
关键词
Brain natriuretic peptide; Cardiac resynchronization therapy; Reverse remodeling; Tumor necrosis factor-alpha; LEFT-VENTRICULAR DYSSYNCHRONY; NATRIURETIC PEPTIDE; RATE-VARIABILITY; SYMPATHETIC ACTIVITY; CYTOKINE RECEPTORS; VAGAL-STIMULATION; NERVE-STIMULATION; PROGNOSTIC VALUE; CRT; EXPRESSION;
D O I
10.1253/circj.CJ-14-0023
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Pro-inflammatory cytokines contribute to the pathophysiology of heart failure (HF) and are up-regulated in affected patients. We investigated whether pro-inflammatory cytokines might predict the response to cardiac resynchronization therapy (CRT). Methods and Results: Plasma levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 were assessed in 91 patients before CRT. Response to CRT was defined as a decrease >= 15% in left ventricular end-systolic volume (LVESV) at 6 months. Baseline TNF-alpha did correlate with LVESV reduction (P=0.001) after CRT. The subject group was divided according to tertiles of TNF-alpha. From the lower to the upper tertile LVESV (-31 +/- 28%, -17 +/- 17%, -9 +/- 22%) and LV end-diastolic volume (-23 +/- 25%, -14 +/- 16%, -4 +/- 18%) were progressively less reduced after CRT (P<0.001). The proportion of responders to CRT was 70%, 42% and 33%, according to the lower, intermediate and upper tertile of TNF-alpha distribution (P=0.01). Serious cardiac events (cardiac death, HF hospitalization or urgent heart transplantation) occurred in 63% of patients in the upper tertile vs. 32% and 17% in the intermediate and lower tertiles, respectively, during a median follow-up of 47 months (P<0.001). Conclusions: Circulating TNF-alpha predicts the degree of LV reverse remodeling after CRT and may contribute to the early identification of those patients at higher risk of events after device implantation.
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收藏
页码:2232 / 2239
页数:8
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