Clinical InvestigationRelation of Inflammatory Status to Major Adverse Cardiac Events and Reverse Remodeling in Patients Undergoing Cardiac Resynchronization Therapy
Section snippets
Study Population
The study population consisted of 140 (112 males; 28 females) patients with symptomatic HF who were referred to the Arrhythmia Center of the University of Florence, Italy. Seventy-one (50.7%) patients had ischemic and 69 patients (49.3%) had idiopathic dilated cardiomyopathy. All ischemic patients had myocardial infarction, at least 3 months before the enrollment. All underwent CRT. The etiology of HF was determined by using routine coronary angiography. Inclusion criteria for patients were:
Clinical Characteristics
Almost all the patients investigated were in NYHA Class III-IV (95%) with a mean left ventricular ejection fraction of 29.9 ± 9.6%. With regard to inflammatory markers, IL-6 and hs-CRP reported a median concentration of 6.82 pg/mL (range 0.7–65.2 pg/mL) and 6.45 mg/L (range 0.1–21.8 mg/L), respectively. One-hundred five (75%) patients reported IL-6 or hs-CRP levels above our reference limits.
Correlation analysis showed a significant positive relationship between the 2 inflammatory markers (r =
Discussion
This study demonstrates that CRT reduces inflammatory status only in patients who undergo an evident reverse remodeling, and that the latter ensues again only in patients who do not have major adverse cardiac events at follow-up. To date, this is the first report that has examined simultaneously the impact of CRT on inflammatory status, left ventricular remodeling, clinical improvement, and adverse cardiac events in HF patients. The main finding of the present study is that reverse remodeling
Limitations
Some limitations can be identified in the present study: we studied patients with left bundle branch block and NYHA Class III-IV on optimized therapy for HF, thus representing a part of the wide spectrum of patients with HF. Furthermore, inflammatory markers present a certain intraindividual variation of the levels, so not fully avoiding the possibility of false negative results.
Conclusions
We suggest IL-6 and CRP to be considered as useful parameters to evaluate efficacy of CRT in terms of left ventricular remodeling and major adverse cardiac events.
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