title: Severity of oxidative stress and inflammatory activation in end-stage heart failure patients are unaltered after 1 month of left ventricular mechanical assistance.
abstract: This study investigates the impact of early left ventricular (LV)-mechanical unloading on systemic oxidative stress and inflammation in terminal heart failure patients and their impact both on multi organ failure and on intensive care unit (ICU) stay. Circulating levels of urinary 15-isoprostane-F(2t) (8-epi-PGF2(α)) and pro-inflammatory markers [plasma interleukin (IL)-6, IL-8, and urinary neopterin, a monocyte activation index] were analyzed in 20 healthy subjects, 22 stable end-stage heart failure (ESHF) patients and in 23 LV assist device (LVAD) recipients at pre-implant and during first post-LVAD (PL) month. Multi-organ function was evaluated by total Sequential Organ Failure Assessment (tSOFA) score. In LVAD recipients the levels of oxidative-inflammatory markers and tSOFA score were higher compared to other groups. After device implantation 8-epi-PGF2(α) levels were unchanged, while IL-6, and IL-8 levels increased during first week, and at 1month returned to pre-implant values, while neopterin levels increased progressively during LVAD support. The tSOFA score worsened at 1 PL-week with respect to pre-implant value, but improved at 1 PL-month. The tSOFA score related with IL-6 and IL-8 levels, while length of ICU stay related with pre-implant IL-6 levels. These data suggest that hemodynamic instability in terminal HF is associated to worsening of systemic inflammatory and oxidative milieu that do not improve in the early phase of hemodynamic recovery and LV-unloading by LVAD, affecting multi-organ function and length of ICU stay. This data stimulate to evaluate the impact of inflammatory signals on long-term outcome of mechanical circulatory support.
authors.affiliation: CNR Clinical Physiology Institute, Cardiovascular Department, Niguarda Cà Granda Hospital, Piazzale Ospedale Maggiore, 3-20162 Milan, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Caruso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Verde
authors.forename: Jonica
authors.initials: J
authors.lastname: Campolo
authors.forename: Filippo
authors.initials: F
authors.lastname: Milazzo
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.forename: Chiara
authors.initials: C
authors.lastname: Boroni
authors.forename: Marina
authors.initials: M
authors.lastname: Parolini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Trunfio
authors.forename: Roberto
authors.initials: R
authors.lastname: Paino
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
authors.forename: Oberdan
authors.initials: O
authors.lastname: Parodi
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010084:Oxidation-Reduction; D018384:Oxidative Stress; D019919:Prosthesis Implantation; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein