Effects of cardiac resynchronization therapy on systemic inflammation and neurohormonal pathways in heart failure.
BACKGROUND
The effect of cardiac resynchronization therapy (CRT) on systemic inflammation and neurohormonal alterations associated with heart failure is not well characterized. Accordingly, we aimed to assess the long term effects of CRT on systemic inflammation and neurohormonal factors in heart failure patients.


RESULTS
In 47 HF patients (NYHA III-IV) we evaluated, at baseline and after one year of CRT: TNF-alpha, TNF soluble receptors (sTNFR1 and sTNFR2), insulin-like growth factor-1alpha (IGF-1alpha), adiponectin, norepinephrine, pro-atrial natriuretic peptide (pro-ANP), N-terminal-pro-brain natriuretic peptide (NT-proBNP) and angiotensin II, NYHA functional class, quality of life (the Minnesota Living with Heart Failure questionnaire), a 6-minute walk test and an echocardiogram. Long-term CRT decreased activation of renin-angiotensin system (RAS) only in patients with reverse remodelling. It failed to prevent a decline in adiponectin levels, regardless of reverse remodelling. NT-proBNP remained unchanged in patients with reverse remodelling, whereas its levels increased in those without reverse remodelling. IGF-1alpha increased with CRT, whereas CRT had no effect on pro-ANP and inflammatory markers.


CONCLUSIONS
Long-term CRT is associated with decreased RAS activation and stabilization of NT-proBNP in heart failure patients with reverse remodelling. Long-term CRT, with or without reverse remodelling, does not affect systemic inflammation and fails to prevent a decline in adiponectin.
Tarquini
Roberto
R
Department of Internal Medicine, University of Florence, Florence, Italy. rtarquini@unifi.it
Guerra
Cristina Tosti
CT
Porciani
Maria Cristina
MC
Michelucci
Antonio
A
Padeletti
Margherita
M
Ricciardi
Giuseppe
G
Chiostri
Marco
M
Jelic
Sania
S
Padeletti
Luigi
L
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002304:Cardiac Pacing, Artificial; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000097:blood*; D011446:Prospective Studies; D011788:Quality of Life; D012084:Renin-Angiotensin System; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling
D015415:Biomarkers; D018836:Inflammation Mediators; D018377:Neurotransmitter Agents