Neurohormonal profile of rheumatic patients with significant chronic aortic regurgitation.
BACKGROUND
Neurohormones are involved in the physiopathology of heart failure, but little is known about its behavior in significant chronic aortic regurgitation (AR). We aimed at analyzing the behavior of these mediators in AF.


OBJECTIVE
We aimed at analyzing the behavior of these mediators in AF.


METHODS
We analyzed 89 patients with AF, whose mean age was 33.6+/-11.5 years and of whom 84.6% were males, 60% asymptomatic, all with rheumatic etiology. After the clinical and echocardiographic assessment, plasma measurements of tumor necrosis factor (TNF), soluble TNF receptor types I and II (sTNFRI e sTNFRII), interleukin-6 (IL-6), its soluble receptor (sIL6R), endothelin-1 and B-type natriuretic peptide (BNP) were carried out; 12 healthy individuals were used as controls.


RESULTS
The mean values of the left ventricle diastolic diameter (LVDD) were 71.9+/-8.3mm, whereas the mean values of the LV systolic diameter (LVSD) were 50.4+/-9.3mm. The neurohormonal levels were elevated in patients with AF (TNF 92.65+/-110.24 pg/mL vs. 1.67+/-1.21 pg/ml in controls, p<0.001), (IL-6 7.17+/-7.78 pg/ml vs. 0.81+/-0.38 pg/mL in controls, p=0.0001) and TNFRI (894.75+/-348.87 pg/mL vs. 521.42+/-395.13 pg/ml, p=0.007). Except for the BNP levels, symptomatic and asymptomatic patients presented a similar neurohormonal profile. There was a correlation between TNFRII and LVDD (r=-0.329, p=0.038) and LVSD (r=-0.352, p=0.027). BNP levels were significantly higher in symptomatic patients and only in the latter it was possible to establish a correlation between BNP and ventricular diameters.


CONCLUSIONS
Patients with significant chronic AF present high neurohormonal levels, with no correlation with the symptomatic status. The TNFRII and BNP levels could be correlated with ventricular diameters, but only the latter could be correlated with symptoms.
Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. guilherme.spina@incor.usp.br
Guilherme Sobreira
GS
Spina
Flávio
F
Tarasoutchi
Roney Orismar
RO
Sampaio
Marcelo Luiz Campos
ML
Vieira
Célia
C
Strunz
Francisco Rafael
FR
Laurindo
Max
M
Grinberg
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D020257:Ventricular Remodeling / Q000502:physiology
D015415:Biomarkers; D015850:Interleukin-6; D047888:Receptors, Tumor Necrosis Factor, Type I; D014409:Tumor Necrosis Factor-alpha; D020097:Natriuretic Peptide, Brain