Does the calcineurin inhibitor have influence on cytomegalovirus infection in heart transplantation?

Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in heart transplant (HTx). Our aim was to analyze the rate of CMV infection in HTx patients receiving treatment with cyclosporine (CsA) or tacrolimus (Tac). Ninety-five patients were randomized to receive either CsA (53.7%) or Tac (46.3%). We performed prophylaxis with valganciclovir in patients with the highest risk of CMV infection. We considered CMV infection as an increased viral load or the presence of CMV in histological samples. We analyzed baseline characteristics, CMV infection, and other complications. Event-free rates were calculated using the Kaplan-Meier method. There were no significant differences in baseline characteristics between both groups. CMV infection was detected in 31.6% of patients (in 66.7% due to asymptomatic replication). The group treated with Tac had a lower rate of CMV infection (15.9% vs. 45.1%, p = 0.002) and longer CMV infection-free survival time (1440 vs. 899 d, p = 0.001). No differences were observed in the complications analyzed in both groups. The independent risk factors for infection identified in the multivariate analysis were treatment with CsA and bacterial infections. This was the first study to demonstrate a lower rate of CMV infection in patients treated with Tac vs. those treated with CsA after HTx.

Impact of basal heart rate on long-term prognosis of heart transplant patients.

Previous studies in patients with heart failure have shown that an elevated basal heart rate (HR) is associated with a poor outcome. Our aim with this study was to investigate if this relationship is also present in heart transplantation (HTx) recipients. From 2003 until 2010, 256 HTx performed in our center were recruited. Patients who required pacemaker, heart-lung transplants, pediatrics, retransplants, and those patients with a survival of less than 1 year were excluded. The final number included in the analysis was 191. Using the HR obtained by EKG during elective admission at 1 year post-HTx and the survival rate, an ROC-curve was performed. The best point under the curve was achieved with 101 beats per minute (bpm), so patients were divided in two groups according to their HR. A comparison between survival curves of both groups was performed (Kaplan-Meier). Subsequently, a multivariate analysis considering HR and other variables with influence on survival according to the literature was carried out. A total of 136 patients were included in the group with HR ≤100 bpm, and 55 in the one with HR >100 bpm. There were no basal differences in both groups except for primary graft failure, which was more frequent in the >100 bpm group (30.9 vs. 17%, P = 0.033). Patients with ≤100 bpm had a better long prognosis (P < 0.001). The multivariate analysis proved that high HR was an independent predictor of mortality. Our study shows that HR should be considered as a prognosis factor in HTx patients.

Serum markers of apoptosis in the early period of heart transplantation.

CONTEXT AND OBJECTIVE: To assess the relationship between levels of serum markers of apoptosis and rejection grades in heart transplant (HTx). MATERIALS AND METHODS: A prospective study was conducted in 91 HTx. We correlated apoptosis markers and biopsy samples. The apoptosis markers were: TRAIL, TRAIL-R1, TRAIL-R2, TRAIL-R3, TRAIL-R4, sFas, sTNF-R1 and sTNF-R2. RESULTS: The only significant correlation with rejection grade was sFas (r=0.329; p=0.005). Cyclosporine showed a proapoptotic effect (sTNF-R1 0.02 and sTNF-R2 0.02) and everolimus an antiapoptotic effect (sTNF-R1 r= -0.523; p=0.0001 and sTNF-R2 r= -0.405; p=0.0001). CONCLUSIONS: The utility of specific apoptosis markers in peripheral blood for diagnosis of acute cellular rejection is low. Everolimus may have an anti-apoptotic effect.

Nurse-led and Interdisciplinary Secondary Cardiovascular Prevention Programmes: Spanish Cohort of the EUROACTION Project.

BACKGROUND: Cardiovascular prevention and rehabilitation programmes (CVPRP) are a preventive tool, which can reverse unhealthy behaviours and improve risk factor management. They have been successfully implemented in a variety of settings in patients with coronary heart disease (CHD). OBJECTIVE: The objective of this study is to evaluate an interdisciplinary and nurse-led cardiovascular prevention and rehabilitation programme in patients with coronary heart disease. METHODS: Six pairs of hospitals were randomised between intervention (INT) and usual care (UC) patients. The interdisciplinary team in the intervention hospital carried out a 16-week CVPRP to reach European risk factor goals. The trial is registered as ISRCTN 71715857. RESULTS: The proportion of patients achieving European cardiovascular recommendations in Spain increased in the intervention hospital, mainly regarding fruit and vegetable consumption (INT 98% vs. UC 53%, p<0.001), oily fish consumption (INT 42% vs. UC 19.5%, p<0.001), self-reported physical activity (INT 31% vs. UC 12.4%, p=0.04), blood pressure (INT 69% vs. UC 47.1%) p< 0.05) and LDL concentrations (INT 86.1% vs. UC 67.6%, p=0.04). CONCLUSION: The EUROACTION nurse-led model of CVPR programme has shown that therapeutic goals in cardiovascular disease prevention are affordable and sustainable in everyday clinical practice. EUROACTION model adapted in Spain has produced a healthier lifestyle.

Psycho-Social Factors in Patients with Cardiovascular Disease Attending a Family-Centred Prevention and Rehabilitation Programme: EUROACTION Model in Spain.

BACKGROUND: Coronary heart disease (CHD) persists as the leading cause of death worldwide. Cardiovascular prevention and rehabilitation (CVPR) has an interdisciplinary focus, and includes not only in physiological components, but it also addresses psycho-social factors. METHODS: The study analysed the Spanish psycho-social data collected during the EUROACTION study. In Spain, two hospitals were randomised in the Valencia community. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out a 16-week CVPR programme, which aimed to assess illness perceptions and establish healthy behaviours in patients and their partners. RESULTS: Illness perceptions were significantly and inversely associated with anxiety and depression. Low levels of anxiety were associated with better self-management of total cholesterol (p = 0.004) and low-density lipoprotein-cholesterol (p = 0.004). There was concordance at one year among patients and partners who participated in the programme related to anxiety (p < 0.001), fruit consumption (p < 0.001), and vegetable consumption (p < 0.001). CONCLUSIONS: The EUROACTION study emphasised the importance of assessing psycho-social factors in a CVPR programme and the inclusion of family as support in patients' changes in behaviour.

Lipid Profile Results after Cardiovascular Prevention Programme: Euroaction Model in Spain.

BACKGROUND: Cardiovascular prevention and rehabilitation programmes (CVPRP) are an established model of care designed to improve risk factor management. They have been successfully implemented in a variety of settings, in patients with coronary heart disease (CHD). OBJECTIVE: To assess the long term impact of a nurse-coordinated, multidisciplinary, CVPRP in patients with CHD in the reduction of lipid profile and medication prescription in clinical practice. METHODS: The study used an analytical, experimental, population based, prospective and longitudinal design. In Spain, the study was conducted in the Valencian Community, including two randomized hospitals. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out an 8-week CVPRP. RESULTS: The proportion of patients achieving improved standards of preventive care increased in the intervention hospital compared with the usual care hospital, mainly regarding LDL-C concentrations. Furthermore, an increased prescription of statins was found in the intervention group. However, there were no statistically significant differences in triglycerides and glucose levels. CONCLUSION: The EUROACTION nurse-led CVPRP enabled coronary patients to control lipid profile to the European targets. A large proportion of patients were prescribed statin therapy as cardioprotective medication with favorable changes in medication for coronary patients. To improve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to the health policy of individual countries.

[Usefulness of the N-terminal fraction of brain natriuretic peptide for deciding when to refer patients with sleep apnea-hypopnea syndrome to the cardiologist]. / ¿Cuándo remitir al cardiólogo al paciente con síndrome de apneas-hipopneas durante el sueño? Utilidad del NT-proBNP.

INTRODUCTION AND OBJECTIVE: When sleep apnea-hypopnea syndrome (SAHS) and cardiovascular disease occur concurrently, prognosis is affected. Echocardiography can detect structural cardiac abnormalities but using this technique in all patients would place a heavy burden on resources. The objective of this study was to investigate whether the N-terminal fraction of brain natriuretic peptide (NT-proBNP) can be used as a marker for silent heart disease. PATIENTS AND METHODS: NT-proBNP concentration was measured in the 114 consecutive patients with SAHS who underwent echocardiography before starting treatment. Left and right ventricular systolic and diastolic function, as well as structural abnormalities, were studied. Correlations between NT-proBNP concentration and the abnormalities detected were investigated. A receiver operating characteristics (ROC) curve was plotted for NT-proBNP concentration and cardiac abnormalities. RESULTS: Data for 98 patients were finally analyzed. NT-proBNP concentration was significantly correlated with ventricular septal thickness (r=0.63), posterior wall thickness (r=0.45), and left ventricular end-diastolic diameter (r=0.51) (P<.0001 for all correlations). The area under the ROC curve was significant (0.870; 95% confidence interval, 0.801-0.939; P<.0001). Assuming that specificity would be more useful for clinical practice, we calculated that NT-proBNP concentrations below 100 and 200 pg/mL could rule out structural abnormalities with a reliability of 90% and 100%, respectively. CONCLUSIONS: NT-proBNP concentration was strongly correlated with echocardiographic abnormalities and so could be a useful tool for identifying patients who should be referred to the cardiologist.

[Clinical-Epidemiological Profile of Patients Initiating Intensive Statin Therapy for the Secondary Prevention of Vascular Disease in Spain]. / Perfil clínico-epidemiológico de pacientes que inician terapia intensiva con estatinas para la prevención secundaria de enfermedad vascular en España.

BACKGROUND: The new recommendations regarding the utilization of high potency statins (intensive therapy) for the treatment of cardiovascular disease have been based on the extrapolation of data coming from clinical trials. The objective is to describe the clinical-epidemiological profile of statin therapy users for the secondary prevention of cardiovascular disease in Spain and to examine the predictors for intensive therapy initiation. METHODS: Cross-sectional study from a sample of 88,751 patients aged ≥45 years-old with previous cardiovascular disease which initiated statin therapy between 1st January 2007 to 31st December 2011. Dose treatments >40 mg simvastatin daily (or equivalent dose if different statin) were considered intensive therapy treatment. Multivariable logistic regression models were built for dependent summary variables to examine the association between and the intensive therapy utilization (vs low-moderate intensity therapy). RESULTS: 16,857 adult patients receiving a first prescription of statin for the secondary prevention of cardiovascular diseases were identified. Predictors for intensive therapy initiation were year of statin prescription, male gender (adjusted OR: 1.70; 95% CI: 1.44-2.00), age >75 years-old (1.39; 1.15-1.69), previous history of coronary artery disease (1.71; 1.44-2.04), previous history of transient ischemic attack (1.24; 0,97-1.59), smoking (1.62; 1.34-1.95), hypertension (1.41; 1.20-1.65) and recent use of fibrates (2.32; 1.27-4.26). CONCLUSIONS: The onset of intensive therapy with statins in secondary was determined by the type of vascular event and age (>75 years-old in which the risk benefit balance could be controversial). No statistically significant differences were found according to the LDL-c levels.

[Prognostic value of troponin T in hospitalized patients with angina or non-ST-segment elevation myocardial infarction]. / Valor pronóstico de la tropinina T en pacientes hospitalizados con angina o infarto sin elevación del segmento ST.

INTRODUCTION AND OBJECTIVES: Cardiac troponins are highly specific and sensitive for detecting minimal myocardial damage. The aim of our study was to determine the prognostic value of troponin T levels in patients hospitalized for suspected angina or myocardial infarction without ST-segment elevation. PATIENTS AND METHOD: We recorded the frequency of death, acute myocardial infarction, heart failure, or need for coronary revascularization in the three months after the onset of symptoms in 346 consecutive patients admitted for suspected acute coronary syndrome, excluding those who developed myocardial infarction with persistent ST-segment elevation. RESULT: . Serum troponin T levels were > or = 0.1 ng/ml in 133 patients (troponin T positive group) and lower in 213 patients (troponin T negative group). The relative risk (RR) and 95 percent confidence intervals (95% CI) of individual and grouped events for the troponin T positive group were 3.2 (95% CI, 1.4-7.3; p = 0.006) for death; 2.8 (95% CI, 1.43-5.51; p = 0.003) for death or myocardial infarction; and 2.8 (95% CI, 1.6-5.0; p < 0.001) for death, myocardial infarction or heart failure. Diabetes mellitus and troponin T levels > or = 0.1 ng/ml had independent prognostic value after adjusting for age, sex, and electrocardiographic changes; with RR 2.5 (95% CI, 1.01-5.9) for death, myocardial infarction or heart failure. CONCLUSIONS: The prognosis of patients hospitalized for chest pain who do not immediately develop transmural necrosis depends on serum troponin T levels at hospital admission. Troponin T levels > or = 0.1 ng/ml almost triple the risk of major events in the three months after the acute episode. The prognostic value of troponin T is independent of age, sex, presence of diabetes mellitus, and electrocardiographic changes.

[Value of NTproBNP concentration in an out-of-hospital adult population]. / Valor del nivel de NTproBNP en población adulta extrahospitalaria.

INTRODUCTION: The diagnosis of chronic heart failure (CHF) is based on demonstrating the cardiac origin of clinical manifestations. Echocardiography is the method of choice for the detection of left ventricular systolic dysfunction (LVSD). Brain natriuretic peptide (BNP) rises during LVSD. OBJECTIVES: To analyze the plasma concentration of N-terminal brain natriuretic propeptide (NTproBNP) in a general adult population in relation to different spontaneous circumstances and to study its capacity for identifying patients with LVSD.Methods. A cardiological examination was made and plasma NTproBNP levels were measured in a randomized group of 203 people (49-81 years old) from the Community of Valencia. RESULTS: The average NTproBNP concentration was 52.2 98.2 pmol/l. NTproBNP levels varied with age, gender and functional stage (NYHA). The highest NTproBNP values were observed in people who had previously suffered from acute pulmonary edema or who had an ejection fraction (EF) of less than 40%. There was also a significant elevation in patients with nocturnal dyspnea, orthopnea, atrial fibrillation, EF < or = 50%, angina, and ankle edema. The best concentration of NTproBNP for differentiating EF < or = 50% was 37.7 pmol/l, with 92% sensitivity and 68% specificity. CONCLUSIONS: The elevation of NTproBNP concentration indicates the cardiac origin of clinical manifestations and serves to select patients for echocardiographic examination. Low NTproBNP concentrations help to rule out LVSD.

Phenotypic patterns of right ventricular dysfunction: analysis by cardiac magnetic imaging.

The aim of this study was to use magnetic resonance imaging (MRI) to classify the morphological changes and remodeling of the right ventricle (RV) that occur in different clinical situations and that have an impact on RV function. Most literature has traditionally focused on the left ventricle (LV) and as a result, few studies analyze RV behavior and remodeling. The study evaluated all cardiac MRI performed at our center from 2008 to 2010. We retrospectively identified 159 patients who had some sign of right ventricular dysfunction (RVD) based on MRI findings. We classified patients according to a combination of criteria for RVD and the presence of left ventricle dysfunction (LVD). We considered RVD as any of the following abnormalities: i) depressed RV function; ii) RV dilatation; iii) RV hypertrophy. LVD was considered when there was atrial dilatation, LV hypertrophy, LV dilatation and/or depressed LV function. We obtained 6 pathophysiological patterns: RV pressure overload (1.9%), RV volume overload (15.7%), RV volume overload + LVD (32.7%), depressed RV function + LVD (42.1%), mixed RV overload + LVD (6.9%) and other (0.6%). The most frequent etiology was congenital heart disease (33.3%), followed by idiopathic dilated cardiomyopathy (18.2%), left valvular disease (17.6%), ischemic heart disease (15%), pulmonary disease (9.8%), and other (6.1%). This study helps to classify the different patterns that RV can adopt in different clinical situations and can, therefore, help us to understand the RV pathophysiology.

Repeated CMV infection in a heart transplantation patient.

Infections are one of the leading causes of morbidity and mortality in heart transplantation (HTx). Cytomegalovirus (CMV) is the most common viral infection during the first year after HTx, but it is more unusual after this time. We present the case of a patient who underwent an HTx due to a severe ischemic heart disease. Although the patient did not have a high risk for CMV, infection, he suffered a reactivation during the first year and then up to six more episodes, especially in his eyes. The patient received different treatments against CMV and the immunosuppression was changed several times. Finally, everolimus was introduced instead of cyclosporine, and mycophenolate mofetil was withdrawn. The presented case provides an example of how the immunosupresion plays a key role in some infections in spite of being a suitable antiviral treatment.

Ischemic time as a predictor of physical recovery in the first months after heart transplantation.

Functional results after heart transplantation range from modest to spectacular improvement. Little is known about factors to predict functional result. This study aimed to identify these factors. We present a prospective study including all consecutive transplant recipients (n = 55) in a two-year period whose survival was greater than two months. Perioperative, donor, and recipient issues were systematically analyzed. Exercise capacity was assessed by symptom-limited treadmill exercise testing two months after transplantation. Exercise capacity was classified as satisfactory or poor depending on achieving or not 4.5 METs (metabolic equivalents), respectively. Thirty-three patients (60%) showed a good exercise capacity (>4.5 METs), whereas the remaining twenty-two patients (40%) were unable to exceed this threshold. The variables which correlated with exercise capacity in univariate analysis were recipient age, inotropic treatment, ischemic time, ventricular assist device, etiology, urgent transplant, and INTERMACS score. Among them only recipient age and ischemic time were proved to be correlated with exercise capacity in the multiple regression analysis. Thus, younger patients and those who had received an organ with shorter ischemic time showed greater exercise capacity after transplant. These findings strengthen the trend toward reducing ischemic time as much as possible to improve both survival and clinical recovery.

Are there differences in acute phase inflammation markers regarding the type of heart failure?

This study aimed to determine if there are differences in inflammatory markers in the acute phase between systolic heart failure and heart failure with preserved systolic function. One hundred and thirty-one patients with acute heart failure were recruited consecutively. At admission, plasma fibrinogen, C-reactive protein, sialic acid, von Willebrand factor, vascular endothelial growth factor, interleukin-6 and NTproBNP were all evaluated. If the ejection fraction was 45% or over patients were included in the HF-PSF group; the remaining patients were included in the SHF group. The HF-PSF patients were older (72±10 vs 63±12 years, P<0.001), presented a higher rate of atrial fibrillation (56.1 vs 21.3%, P<0.001), and had a lower rate of hemoglobin (12.2±2 vs 13.3±2.1 g/dL, P<0.01). No significant differences were observed in the inflammation markers analyzed among SHF and HF-PSF groups. In the acute phase of heart failure there is a marked elevation of inflammatory markers but there are no differences in the inflammatory markers analyzed between the two different types of heart failure.

Repeated daclizumab administration to delay the introduction of calcineurin inhibitors in heart transplant patients with postoperative renal dysfunction.

Daclizumab is an interleukin-2 receptor antagonist which is used for induction therapy in heart transplant patients. It has few side effects and is associated with a low infection rate. Postoperative renal failure after heart transplantation is common and potentially fatal. The administration of calcineurin inhibitors in the postoperative period can aggravate the situation. We report the cases of six patients who underwent heart transplantation and developed acute renal failure in the immediate postoperative period. All were administered daclizumab weekly to avoid the introduction of calcineurin inhibitors and to facilitate recovery of renal function. Calcineurin inhibitors were introduced only once renal function had improved. Renal function recovered in all cases and there was a low complication rate. The administration of repeated doses of daclizumab to patients who experience acute postoperative renal failure after heart transplantation may provide an alternative therapeutic approach that enables calcineurin inhibitors to be avoided and, consequently, renal function to recover.

Predictors of renal dysfunction at 1 year in heart transplant patients.

BACKGROUND: Renal dysfunction (RD) is one of the most significant long-term complications of heart transplantation (HT). Although RD is generally attributed to a direct effect of calcineurin inhibitors, it is more probable that multiple factors contribute to its development. The aim of this study was to search for predictor variables of RD at 1 year after HT. METHODS: Three hundred sixteen consecutive HT patients were evaluated. The relationship between RD at 1 year (glomerular filtration rate <60 mL/min/1.73 m2), and pretransplant and 1-year follow-up variables was analyzed. RESULTS: At 1 year following HT, 181 patients (57%) had a glomerular filtration rate of <60 mL/min/1.73 m2. On multivariate analysis, pretransplant serum creatinine values (odds ratio [OR] 5.106, 95% confidence interval [CI]: 2.35-11.09, P=0.0001) and cytomegalovirus (CMV) infection (OR 2.04, 95% CI: 1.08-3.83, P=0.027) were significant predictors of RD, and diabetes mellitus was almost significant (OR 1.65, 95% CI: 0.98-2.76, P=0.055). Variables protective against RD were induction therapy with interleukin-2 receptor antagonists versus muromonab-CD3 (OR 0.389, 95% CI: 0.24-0.61, P=0.0001), maintenance treatment with mycophenolate mofetil versus azathioprine (OR 0.42, 95% CI: 0.26-0.68, P=0.0001), and CMV antiviral prophylaxis (OR 0.38, 95% CI: 0.17-0.68, P=0.021). CONCLUSIONS: Fifty-seven percent of HT patients had RD at 1 year posttransplant. RD was associated with pretransplant serum creatinine values, CMV infection, and diabetes mellitus. Induction with interleukin-2 receptor antagonists, treatment with mycophenolate mofetil, and antiviral prophylaxis for CMV infection all helped maintain renal function in this cohort of HT patients.

Reversal of protein-losing enteropathy after heart transplantation in young patients.

Protein-losing enteropathy is a rare but life-threatening complication that occurs in some patients who develop intestinal lymphangiectasis secondary to increased systemic venous pressure. Although different forms of treatment have been tried, with varying results, the majority were reported to be unsuccessful. The aim of this study was to demonstrate that heart transplantation may be an appropriate therapeutic option for patients who do not respond to medical treatment. At our center, we performed heart transplantations in three patients with this condition. The mean follow-up period was 11+/-2 months. No patient died and the enteropathy regressed in all three.

Inflamación y disfunción endotelial en la insuficiencia cardíaca aguda y crónica / Endothelial dysfunction and inflammation in chronic and acute heart failure / Inflamação e disfunção endotelial na insuficiência cardíaca aguda e crônica

Introducción. En la insuficiencia cardíaca (IC) existe una importante activación neurohormonal e inflamatoria. También parece existir una disfunción endotelial. Nuestro objetivo ha sido comparar ambos procesos (inflamación y disfunción endotelial) en pacientes con IC. Material y métodos. Comparamos marcadores de disfunción endotelial (células endoteliales circulantes, macropartículas circulantes y factor von Willebrand) y de inflamación (proteína C reactiva, interleuquina 6 y fibrinógeno funcional) en 16 pacientes con insuficiencia cardíaca aguda (ICA), 16 con insuficiencia cardíaca crónica (ICC) estable y 32 controles sanos. Resultados. El número de células endoteliales circulantes fue mayor en los pacientes con ICA que en el grupo ICC y que en el grupo control (115,10 ± 63,44 vs 19,67 ± 3,17 vs 11,71 ± 2,92 cel/mL). La cantidad de macropartículas circulantes fue mayor en el grupo ICA que en el ICC y en ambos grupos frente al grupo control (9.627 ± 4.986 vs 3.970 ± 3.452 vs 1.371 ± 739 p/µL). El factor von Willebrand fue mayor en ambos grupos IC que en el control (234,3 ± 45,31 vs 245,92 ± 117,89 vs 100,14 ± 20,7%). Los valores de proteína C reactiva fueron mayores en el grupo ICA que en el ICC y que en el control (20,29 ± 17,56 vs 7,65 ± 4,27 vs 1,44 ± 1,10 mg/dL). La interleuquina 6 se encontró más elevada en los pacientes con ICA respecto al resto de grupos y en los pacientes con ICC respecto a los sanos (9,73 ± 9,37 vs 1,69 ± 1,36 vs 1,01 ± 1,09 pg/mL). Referente al fibrinógeno funcional, sólo encontramos diferencias significativas entre el grupo ICA y el resto de grupos (350 ± 60,48 vs 264,08 ± 67,02 vs 254,29 ± 23,69 mg/dL). Conclusiones. De forma paralela a la inflamación ya conocida en la IC, se produce una disfunción endotelial que a su vez parece ser proporcional a la gravedad de la IC.

Background. There is a neurohormonal an inflammatory activation in heart failure. There is also an endothelial dysfunction. Our objective war to compare both processes (inflammation and endothelial dysfunction) in patients with heart failure. Material and method. We compared endothelial dysfunction markers (circulating endothelial cells, circulating microparticles and Von Willebrand factor) and inflammatory markers (C reactive protein, interleukin-6 and functional fibrinogen) in 16 patients with acute heart failure (AHF), 16 with stable chronic heart failure (SHF) and 32 healthy controls. Results. The number of circulating endothelial cells was greater in AHF patients than in SHF and controls (115.10± 63.44 vs 19.67 ± 3.17 vs 11.71 ± 2.92 cel/mL). The amount of circulating microparticles was greater in the AHF group than in the SHF and in both than controls (9,627 ± 4,986 vs 3,970 ± 3,452 vs 1,371 ± 739 p/µL). Von Willebrand factor was greater in both heart failure groups than in controls (234.3 ± 45.31 vs 245.92 ± 117.89 vs 100.14± 20.7%). C reactive protein was greater in the AHF group than in the SHF group or controls (20.29 ± 17.56 vs 7.65± 4.27 vs 1.44 ± 1.10 mg/dL). Interleukin-6 was also higher in the AHF group than in the SHF and in this greater than in controls (9.73 ± 9.37 vs 1.69 ± 1.36 vs 1.01 ± 1.09 pg/mL). Functional fibrinogen was only greater in the AHF group (350 ± 60.48 vs 264.08 ± 67.02 vs 254.29 ± 23.69 mg/dL). Conclusions. Inflammation and endothelial dysfunction run together in heart failure patients. The endothelial dysfunction observed seems to be proportional to the inflammatory state.

Introdução. Na insuficiência cardíaca existe uma importante ativação neurohormonal e inflamatória. Também parece existir uma disfunção endotelial. Nosso objetivo foi o de comparar ambos processos (inflamação e disfunção endotelial) em pacientes com insuficiência cardíaca. Materiais e métodos. Comparamos marcadores de disfunção endotelial (células endoteliais circulantes, micropartículas circulantes e fator Von Willebrand) e de inflamação (proteína C reativa, interleuquina 6 e fibrinogênio funcional) em 16 pacientes com insuficiência cardíaca aguda (ICA), 16 com insuficiência cardíaca crônica estável (ICC) e 32 controles sãos. Resultados. O número de células endoteliais circulantes foi maior nos pacientes com ICA que no de ICC e que no controle (115,10 ± 63,44 vs 19,67 ± 3,17 vs 11,71 ± 2,92 cel/mL). A quantidade de micropartículas circulantes foi maior no grupo de ICA que no de ICC e em ambos grupos de pacientes em frente ao grupo controle (9.627 ± 4.986 vs 3.970 ± 3.452 vs 1.371 ± 739 p/µL). O fator Von Willebrand foi maior em ambos grupos de insuficiência cardíaca que no controle (234,3 ± 45,31 vs 245,92 ± 117,89 vs 100,14 ± 20,7%). Os valores de proteína C reativa foram maiores no grupo de ICA que no de ICC e que no de sãos (20,29 ± 17,56 vs 7,65 ± 4,27 vs 1,44 ± 1,10 mg/dL). A interleuquina seis encontrou-se mais elevada nos pacientes com ICA com respeito ao resto de grupos e nos pacientes com ICC com respeito aos sãos (9,73 ± 9,37 vs 1,69 ± 1,36 vs 1,01 ± 1,09 pg/mL). Com respeito ao fibrinogênio funcional só encontramos diferenças significativas entre o grupo de ICA e o resto de grupos (350 ± 60,48 vs 264,08± 67,02 vs 254,29 ± 23,69 mg/dL). Conclusões. De forma paralela à inflamação já conhecida na insuficiência cardíaca, se produz uma disfunção endotelial que a sua vez parece ser proporcional à gravidade da insuficiência cardíaca.