title: Neurohormones and inflammatory mediators in patients with heart failure undergoing cardiac resynchronization therapy: time courses and prediction of response.
abstract: Despite interest in neurohormonal activation as a determinant of prognosis in chronic heart failure (CHF) and as a target for pharmacological treatments, data are lacking on the time-related effects of electrical cardiac resynchronization therapy (CRT) on a broad spectrum of neurohormones and cytokines. The aim of this study was to assess time-courses and extents of changes within the neurohormonal profile of CHF patients treated with CRT. We performed a prospective follow-up study in 32 patients with NYHA class III-IV CHF to investigate the effects of CRT on a broad panel of neurohormones proposed for characterization of CHF patients. Levels of atrial and brain natriuretic peptides (ANP, BNP), epinephrine, norepinephrine, aldosterone, plasma renin activity, IL-6, TNF, soluble receptors sTNFR1 and 2, and chromogranin A were assessed before implantation and after 3 months of CRT; when feasible, measurements were also performed at 1 week, 1 month and 12 months (clinical evaluation, echocardiography and ECG were also performed at each time-point). The results showed that at 3 months improvement in NYHA class and echographically assessed left ventricular (LV) reverse structural remodeling were accompanied by significant reductions versus baseline in ANP and BNP, but not in other neurohormones. Moreover a baseline ANP concentration < or = 150 pg/ml was a good predictor of response to CRT in terms of NYHA class reduction and reverse LV remodeling. In conclusion 3 months of CRT significantly reduce natriuretic peptides concentrations, while values of other neurohormones and inflammatory cytokines are relatively unvaried. A baseline ANP concentration < or = 150 pg/ml might be a clinically useful predictor of medium-term response to CRT.
authors.affiliation: Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy. giuseppe.boriani@unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.forename: Davide
authors.initials: D
authors.lastname: Saporito
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Tiziano
authors.initials: T
authors.lastname: Toselli
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Gloria
authors.initials: G
authors.lastname: Francolini
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D005260:Female; D006333:Heart Failure / Q000378:metabolism* / Q000628:therapy*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000737:chemistry; D018377:Neurotransmitter Agents / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy
chemical_list: D018377:Neurotransmitter Agents; D020097:Natriuretic Peptide, Brain