Heart failure
Relation Between CD4+ T-Cell Activation and Severity of Chronic Heart Failure Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2007.03.052Get rights and content

The percentage of CD4+ T cells in blood is correlated with left ventricular dysfunction and decreased ejection fraction in heart disease. The aim of this study was to determine the relation between activation of CD4+ T cells and New York Heart Association functional classes in chronic heart failure (HF) and differences in inflammatory activation between ischemic cardiomyopathy (IC) and idiopathic dilated cardiomyopathy (IDC). Blood samples were obtained from 47 patients with HF and 20 controls. Percentages of interferon-γ–positive CD4+ T cells (representative type 1 T-helper cells) and interleukin-4–positive CD4+ T cells (representative type 2 T-helper cells) were analyzed using 3-color flow cytometry. The proportion of interferon-γ–positive CD4+ T cells was higher in patients with HF (28.96 ± 12.90%) than in controls (18.12 ± 5.28, p = 0.0006), but there was no difference in percentage of interleukin-4–positive CD4+ T cells between the 2 groups. The proportion of interferon-γ–positive CD4+ T cells and plasma B-type natriuretic peptide levels increased with worsening of New York Heart Association functional class in the IC and IDC groups. The proportion of interferon-γ–positive CD4+ T cells in the IC group (33.88 ± 13.33%) was higher than in the IDC group (22.33 ± 8.88%, p = 0.002); however, plasma B-type natriuretic peptide levels were higher in the IDC group (358.0 pg/ml, 327.5 to 1,325.7) than in the IC group (82.7 pg/ml, 34.7 to 252.9, p = 0.019). In conclusion, we demonstrated pronounced type 1 T-helper cell activation in patients with HF in proportion to severity of HF and that the specificity of T-cell activation differs between patients with IC and those with IDC.

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Methods

The study consisted of 47 consecutive patients with IC and IDC (38 men and 9 women, mean age 64 ± 10 years). Diagnosis of heart disease was based on clinical history, physical examination, and results of electrocardiography, chest x-ray, echocardiography, left ventriculography, and coronary angiography. Severity of cardiac disease of patients in New York Heart Association (NYHA) functional class I did not limit physical activity such that ordinary physical activity did not cause undue fatigue,

Results

Clinical characteristics of patients and controls are listed in Table 1. The HF and control groups were matched for age, gender, and frequency of coronary risk factors. Heart rate at rest was higher in the HF group than in the control group. More patients in the IDC group were treated with angiotensin-converting enzyme inhibitor and diuretics, whereas more patients in the IC group were treated with nitrate/nitrite, calcium channel blockers, and statins.

Representative fluorescence-activated cell

Discussion

In this study, we elucidated more pronounced type 1 T-helper cell activation in patients with HF, and this increased activation was proportional to disease severity in the IC and IDC groups. Plasma BNP levels have also been linked to degree of left ventricular remodeling, damage, or dysfunction,7, 8, 9 and in support of this, our HF group had higher BNP levels in their blood compared with the control group. These increased levels correlated with increasing NYHA functional class of the patient

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  • Cited by (0)

    This study was supported in part by Grant-in-Aid C17590751 for Scientific Research from the Ministry of Education, Science, and Culture in Japan and a grant from the Japan Arteriosclerosis Prevention Fund, Tokyo, Japan.

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