Inflammation in right ventricular dysfunction due to thromboembolic pulmonary hypertension.
OBJECTIVE
Activation of the immune system is well established in patients with chronic heart failure (CHF) and impaired left ventricular function. High levels of pro-inflammatory cytokines are associated with a poor prognosis. Chronic thromboembolic pulmonary hypertension (CTEPH) frequently leads to impaired right ventricular function. It is not known whether such patients display chronic immune activation as well.


RESULTS
We studied 49 patients with CTEPH (50±2 years, right ventricular ejection fraction [RVEF] 29±2%, left ventricular ejection fraction [LVEF] 51±3%, mean±SEM) and compared their results with 17 patients with CHF (71±2 years, LVEF 23±1%) and 34 age-matched control subjects (age 57±2 years). We studied serum levels of tumor necrosis factor-α (TNFα), its soluble receptors 1 and 2 (sTNFR1 and 2), interleukin-10 (IL-10) and plasma N-terminal-pro-B-type natriuretic peptide (NT-proBNP). Serum TNFα was not different in CTEPH compared with CHF patients (p=0.67) but both their levels were significantly higher than in controls (both p<0.001). Similar results were obtained for sTNFR1, sTNFR2, and IL-10. Levels of NT-proBNP were not different in patients with CTEPH or CHF (p=0.54), but significantly higher than in control subjects (both p<0.001). There were significant correlations between RVEF as assessed by magnetic resonance imaging and sTNFR1, sTNFR2, IL-6, high sensitivity C-reactive protein, and NT-proBNP (all p<0.05) in patients with CTEPH.


CONCLUSIONS
Similar levels of immune activation as reflected by high levels of pro-inflammatory cytokines are present in patients with isolated right ventricular dysfunction due to CTEPH and patients with CHF and left ventricular dysfunction.
Department of Medicine II, Johannes Gutenberg-University, Mainz, Germany.
Stephan
S
von Haehling
Ralph S
RS
von Bardeleben
Thorsten
T
Kramm
Yardena
Y
Thiermann
Margit
M
Niethammer
Wolfram
W
Doehner
Stefan D
SD
Anker
Thomas
T
Munzel
Eckhard
E
Mayer
Sabine
S
Genth-Zotz
D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D007249:Inflammation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D018497:Ventricular Dysfunction, Right / Q000150:complications*