title: [Activation of neurohormonal system as an independent mechanism of heart remodeling in patients with chronic obstructive pulmonary disease].
abstract: OBJECTIVE
  To evaluate the contribution of activation of cytokines and renin-angiotensin-aldosterone system to heart remodeling in patients with chronic obstructive pulmonary disease in the course of a 2 year study and to estimate its relation to severe pulmonary hypertension.
  
  
  METHODS
  117 patients with COPD underwent measurement of TNFα, IL-6 levels and renin levels, spirometry and echocardiography (mean pressure in pulmonary artery, MPPA)). The data obtainedwere compared with the degree of remodeling of right and left ventricles. After 2 years 30 and 33 of the 63 patients were referred to groups with aggressive and moderate remodeling of the right ventricle respectively. Regressive analysis was used to detect predictors of aggressive remodeling.
  
  
  RESULTS
  Initial remodeling severity and rate showed stronger correlation with TNFα, IL-6 levels and renin levels than with MPPA. Multifactor analysis demonstrated that renin activity and creatinine level were the most reliable predictors of remodeling (p = 0.041 and 0.049 respectively).
  
  
  CONCLUSIONS
  Neurohormonal and imunno-inflammatory changes stimulate remodeling of right and left heart chambers. They independently affect myocardium and their influence is only partly mediated through exacerbation of pulmonary hypertension.
authors.forename: A A
authors.initials: AA
authors.lastname: Nekrasov
authors.forename: A N
authors.initials: AN
authors.lastname: Kuznetsov
authors.forename: O V
authors.initials: OV
authors.lastname: Mel'nichenko
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D011660:Pulmonary Heart Disease / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D012044:Regression Analysis; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D020257:Ventricular Remodeling
chemical_list: D015850:Interleukin-6; D010446:Peptide Fragments; D014409:Tumor Necrosis Factor-alpha; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D012083:Renin