CD4+ CD28(null) cells are an independent predictor of mortality in patients with heart failure.
OBJECTIVE
Immune activation and subsequent release of proinflammatory cytokines plays a central role in the pathophysiology of chronic heart failure (CHF). Cytotoxic CD4(+)CD28(null) cells are generated under inflammatory conditions and implicated in a variety of pathological processes like atherosclerosis and autoimmune diseases. The study aim was to assess the impact of CD4(+)CD28(null) cells on survival in CHF patients.


RESULTS
Circulating lymphocytes from 107 CHF patients were analyzed for the distribution of CD4 subsets by flow cytometry. During a median follow-up of 23 months, 22 (20%) persons died. CD4(+)CD28(null) cells independently predicted all-cause mortality with an adjusted hazard ratio (HR) of 1.88 per 1-standard deviation increase (95% confidence interval (CI): 1.26-2.79, P = 0.002) and with a HR of 1.83 for cardiovascular mortality (95% CI: 1.18-2.86, P = 0.008), respectively. Further, we found a significant association with NT-proBNP (r = 0.23).


CONCLUSIONS
Circulating CD4(+)CD28(null) cells are associated with CHF severity and are a strong and independent predictor of mortality in CHF fostering the implication of the immune system in CHF pathophysiology.
Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Lorenz
L
Koller
Bernhard
B
Richter
Georg
G
Goliasch
Steffen
S
Blum
Magdalena
M
Korpak
Gerlinde
G
Zorn
Mira
M
Brekalo
Gerald
G
Maurer
Johann
J
Wojta
Richard
R
Pacher
Martin
M
Hülsmann
Alexander
A
Niessner
D000368:Aged; D015992:Body Mass Index; D018106:CD28 Antigens / Q000378:metabolism*; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology* / Q000276:immunology; D049109:Cell Proliferation; D005260:Female; D005434:Flow Cytometry; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007107:Immune System; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000737:chemistry; D010446:Peptide Fragments / Q000737:chemistry; D011379:Prognosis; D016016:Proportional Hazards Models; D013997:Time Factors
D018106:CD28 Antigens; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
CD4(+)CD28(null) cells; Heart failure; Immune system; Survival