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SYSTEMIC INFLAMMATION AND OXIDATIVE STRESS ARE INCREASED IN PATIENTS WITH DECOMPENSATED CONGESTIVE HEART FAILURE: IMPROVEMENT AFTER SHORT-TERM INOTROPIC SUPPORT
M White, A Ducharme, R Ibrahim, L Whittom, MC Guertin, N Racine, Y He, R Touyz
Montreal, Quebec
BACKGROUND: Patients with severe congestive heart failure (CHF) exhibit an increase in neurohumoral activation and in plasma levels of proinflammatory cytokines. The impact of the severity of CHF on the circulating level of proinflammatory cytokines and on the markers of oxidative stress has not been investigated. The primary objective of this study was to comprehensively evaluate the change in selected proinflammatory cytokines and in systemic markers of oxidation in patients with decompensated CHF compared with healthy controls. The secondary objective was to evaluate the impact of short-term inotropic support on these parameters.
METHODS: Twenty-nine patients with worsening CHF, with NYHA class IIIb to IV, aged 62±14 years (mean ±SD) and left ventricular ejection fraction = 23.7±9.6%, were recruited. These data were compared with 15 age-matched healthy volunteers. The cytokines IL-6, IL-18, the chemokine MCP-I, adhesion molecules sICAM, and E-selectin, and the systemic markers of oxidation MDA, isoprostanes (isoprost) and nitrotyrosine (nitroty) were measured by Elisa and colorimetric assays at the time of admission and 30 days following a 72-hour infusion of milrinone (n=15) or dobutamine (n=14). NYHA class improved significantly from baseline [(NYHA class III, n=8; NYHA IV, n=21) to 30 days (NYHA II, n=10; NYHA III, n=18; NYHA IV, n=1; p<0.005)]. The results for selected markers are presented.
CONCLUSIONS: Patients with decompensated CHF exhibit a marked increase in the markers of inflammation/oxidation. Short-term inotropic support improves functional status and significantly reduces indices of inflammation and oxidative stress.
DNC