title: Cardiac resynchronization therapy increases plasma levels of the endogenous inotrope apelin.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) has been introduced to treat drug refractory chronic heart failure (CHF). Apelin, the endogenous ligand of the APJ receptor, is under evaluation for its potential role in human CHF pathophysiology. This study aims to assess whether biventricular pacing affects plasma apelin levels in patients with severe CHF.
  
  
  RESULTS
  Fourteen patients (9 men, 5 women, mean age 68+/-13 years) undergoing biventricular pace-maker/ICD implantation were studied. Patients underwent baseline clinical and echocardiographic evaluation, and assessment of plasma apelin and NT-proBNP levels. The evaluation was repeated 48 h and 9+/-2 months after device implantation to assess the acute and chronic effects of CRT on apelin and NT-proBNP levels. Eight healthy age- and sex-matched subjects served as controls. In CHF patients, baseline apelin levels were reduced and NT-proBNP increased compared to control subjects (apelin: 0.47+/-0.2 vs. 0.97+/-0.3 ng/mL, p<0.001; NT-proBNP: 2007+/-114 vs. 229+/-72 pmol/L, p<0.001). Short-term evaluation did not reveal any effect of CRT on apelin or NT-proBNP levels. By contrast, at 9+/-2 months follow-up, CRT responders showed left ventricular reverse remodelling and an increase in ejection fraction, together with a significant increase in plasma apelin levels (0.99+/-0.1 vs. 0.47+/-0.2 ng/mL, p<0.001) and decrease in NT-proBNP (938+/-591 vs. 2007+/-114 pmol/L, p<0.05).
  
  
  CONCLUSIONS
  Long-term CRT increases plasma levels of the endogenous inotrope apelin in patients with CHF.
authors.affiliation: Division of Cardiology, 2nd Faculty of Medicine, University La Sapienza, Sant'Andrea Hospital, Rome, Italy. p.francia@tiscali.it <p.francia@tiscali.it>
authors.forename: Pietro
authors.initials: P
authors.lastname: Francia
authors.forename: Adriano
authors.initials: A
authors.lastname: Salvati
authors.forename: Cristina
authors.initials: C
authors.lastname: Balla
authors.forename: Paola
authors.initials: P
authors.lastname: De Paolis
authors.forename: Erika
authors.initials: E
authors.lastname: Pagannone
authors.forename: Marina
authors.initials: M
authors.lastname: Borro
authors.forename: Giovanna
authors.initials: G
authors.lastname: Gentile
authors.forename: Maurizio
authors.initials: M
authors.lastname: Simmaco
authors.forename: Luciano
authors.initials: L
authors.lastname: De Biase
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000073861:Apelin; D015415:Biomarkers / Q000097:blood; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: C115436:APLN protein, human; D000073861:Apelin; D015415:Biomarkers; D036341:Intercellular Signaling Peptides and Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain