Clinical Investigation
Relation of Inflammatory Status to Major Adverse Cardiac Events and Reverse Remodeling in Patients Undergoing Cardiac Resynchronization Therapy

https://doi.org/10.1016/j.cardfail.2006.11.013Get rights and content

Abstract

Background

Inflammatory markers are involved in heart failure (HF) pathophysiology. However, the link between these markers and reverse remodeling as well as major adverse cardiac events (HF death, sudden death, and unplanned cardiac rehospitalizations) in patients who undergo cardiac resynchronization therapy (CRT) has not been evaluated.

Methods and Results

We recorded major adverse cardiac events of 140 patients (on optimized medical therapy, left ventricular ejection fraction 29.9 ± 9.6%, New York Heart Association Class III-IV, with intraventricular dyssynchrony) who underwent CRT (enrolled since April 2004). Moreover, we evaluated before and after 6 months of CRT: interleukin-6, high-sensitivity C-reactive protein, New York Heart Association class, quality of life (score on Minnesota Living with Heart Failure questionnaire), 6-minute walking test, left ventricular end-diastolic and end-systolic volumes (nonindexed and indexed by body surface area), and left ventricular ejection fraction. Adverse cardiac events were observed in 40 patients (28.6%): 22 deaths and 18 cardiac unplanned rehospitalizations. Only patients without adverse events during follow-up showed a significant reduction of inflammatory markers and left ventricular volumes (reverse remodeling), despite a significant improvement of clinical status observed in both groups of patients.

Conclusions

The reduction of inflammatory status seems to be linked to reverse remodeling as well as to a better clinical prognosis in patients with HF who underwent CRT.

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.

References (20)

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