Cytokines and heart rate variability in patients with chronic heart failure.

INTRODUCTION: Heart rate variability (HRV) analysis is a non-invasive method of assessment of the autonomic nervous system's effects on heart function. In chronic heart failure (CHF), decreased HRV correlates with the progression of the disease. It is also known that in CHF increased levels of proinflammatory cytokines are present. Because these molecules are believed to influence the nervous system at both the central and peripheral levels, their potential role in HRV reduction in the course of CHF has been proposed. AIM: The study was designed to verify potential relations between cytokines and HRV parameters in CHF patients. The concept of the study was driven by the recognition of controversies in this field and the paucity of published reports. METHODS: Forty-four patients with CHF and stable NYHA class I-IV symptoms and 15 healthy controls were enrolled in the study. Time-domain HRV analysis was performed based on of 24-hour Holter ECG monitoring. Plasma concentrations of soluble TNFalpha receptors sTNF-RI and sTNF-RII and interleukin 6 (IL-6) were measured using commercially available ELISA kits (Quantikine, RD Systems). RESULTS: In patients with CHF, HRV indices included in the analysis were significantly decreased, and the levels of cytokines increased in comparison with the control group. In the whole study population, both in the CHF patients and the control group, significant negative correlations were observed between sTNF-RI level and long-term HRV indices such as SDNN (r=-0.44; p=0.0006), SDANN (r=-0.44; p=0.0005) and short-time index SDNNI (r=-0.37; p=0.004). Similar negative correlations were found between sTNF-RII level and SDNN (r=-0.35; p=0.007), SDANN (r=-0.34; p=0.01), and SDNNI (r=-0.31; p=0.02), as well as between IL-6 level and SDNN (r=-0.41; p=0.001), SDANN (r=-0.44; p=0.0005) and SDNNI (r=-0.34; p=0.009). CONCLUSIONS: Significant negative correlations between TNF-alpha soluble receptors sTNF-RI, sTNF-RII and IL-6 levels and time-domain HRV parameters were observed in the study. Because the results of investigations conducted so far do not elucidate the cause-effect relationship, further studies are needed to clarify the mechanisms of HRV depression in CHF and the role of cytokines in this severe clinical condition.

[Cardiopulmonary exercise testing and cytokines in chronic heart failure. Comparison of patients with ischaemic and with dilated cardiomyopathy]. / Wyniki testu spiroergometrycznego i wartosci wybranych wskazników odczynu zapalnego u chorych z przewlekla niewydolnoscia serca. Porównanie chorych z kardiomiopatia niedokrwienna i rozstrzeniowa.

Heart failure (HF) is a complex clinical syndrome due to ischaemic heart disease, idiopathic cardiomyopathy, hypertension, valve heart disease and others. It is not clear if the etiology of HF influences decreased in this syndrome exercise tolerance. Controversial is also dependence of cytokine levels on etiology of HF. The aim of the study was to compare exercise capacity and cytokines levels in pts with ischaemic and dilated cardiomyopathy. We analyzed circulating levels of TNF-alpha and its soluble receptors sTNF-RI and sTNF-RII, and interleukin-1beta (IL-1beta), and interleukin-6 (IL-6) in 41 pts with CHF, functional class NYHA I-IV, mean EF--25.2 +/- 7.1%. For determination of cytokines level (using R & D System tests) venous blood was withdrawn after 30 minutes of supine rest. All underwent echocardiography and cardiopulmonary exercise stress testing. Dilated cardiomyopathy (DCM) was diagnosed in 21 pts, ischaemic (ICM) in 20 pts. Pts with DCM were younger then with ICM (48 +/- 6.6 vs 56 +/- 6.6 yrs; p = 0.001). There were no significant differences between groups concerning BMI and EF. There were no significant differences in the level of TNF-alpha and sTNF-RI between groups. There was a trend of increased sTNF-RII in pts with ICM (3179.7 +/- 832.7 vs 2699 +/- 680.1 pg/ml; p = 0,07), IL-1beta (2.55 +/- 2.41 vs 1.49 +/- 1.68 pg/ml; p = 0.087) and IL-6 (6.25 +/- 2.21 vs 4.98 +/- 3.64 pg/ml; p = 0.065), and significant increased ESR (11.2 +/- 9.5 vs 5.5 +/- 4.7 mm/h; p = 0.04). Peak VO2 was reduced in pts with ICM group as compared to those with DCM (14.1 +/- 3.7 vs 18.1 +/- 4.8 ml/kg/min; p = 0.0069). In chronic heart failure circulating levels of cytokines tended to be higher in pts with ischaemic origin of the syndrome. The exercise capacity is lower in ischaemic cardiomyopathy.

Blood pressure, left ventricular mass and function in adult patients after successful repair of coarctation of the aorta.

BACKGROUND: In spite of surgical correction, arterial hypertension may persist in a significant proportion of patients with aortic coarctation. AIM: To asses arterial blood pressure (BP) and left ventricular (LV) mass and function in adult patients who underwent surgical repair of aortic coarctation. METHODS: The study group consisted of 56 patients (27 females, 29 males, mean age 31.2+/-10 years), who underwent surgery due to aortic coarctation at the mean age of 11.53+/-8 years. The control group consisted of 61 healthy subjects. The following parameters were analysed: BP values, end-diastolic interventricular septum (IVS) and posterior wall (PW) thickness, end-diastolic LV diameter, residual stenosis of descending aorta, LV ejection fraction, LV mass (LVM), LVM index (LVMI) and parameters of diastolic LV function. RESULTS: Hypertension was diagnosed in 55% of patients, particularly in those who underwent surgery in more advanced age. In 21 patients the residual pressure gradient through the descendent aorta exceeded 20 mmHg; 14 of them had hypertension. Echocardiography showed significantly higher values of PW thickness in patients than in controls, and significantly higher values of PW, IVS, LVM and LVMI in patients with rather than without hypertension. The most pronounced differences in these parameters were noted between controls and patients with hypertension. In patients with residual trans-aortic gradient, all the above mentioned parameters were similar to those obtained in patients without the gradient or controls. Also, both systolic and diastolic LV function were similar in patients and controls, in patients with or without hypertension, and in patients with or without residual aortic gradient. In the whole study group, a positive linear correlation between age at surgery and BP values was found (p=0.01) whereas no such correlation was found between BP and time which elapsed after surgery. There was a significant negative correlation between E/A and age at surgery (p=0.004) and a positive correlation between time from surgery and IVRT (p=0.025). IVRT positively correlated with BP (p=0.024). BP values correlated positively with PW (p=0.024) and IVS (p=0.04). Among patients with hypertension, a significant positive correlation between age at surgery and LVM (p=0.034) as well as LVMI (p=0.013) was noted. Diastolic LV function in the subgroup of patients with hypertension was characterised by a negative correlation between age at surgery and E/A (p=0.001) and a positive correlation between time from surgery, BP values and IVRT (p=0.045 and p=0.024, respectively). In patients without hypertension no significant correlation between the analysed parameters was found. CONCLUSIONS: 1. Hypertension is present in more than half of adult patients after surgical repair of aortic coarctation, is more frequent in patients who underwent surgery at a more advanced age, and in the majority of patients is not associated with the presence of residual trans-aortic gradient. 2. LV thickness, mass and index increase due to hypertension, regardless of the presence of gradient. 3. LV diastolic parameters are similar to those in healthy subjects, however, they become impaired as the time from surgery increases, particularly in patients who underwent repair at an advanced age and who have hypertension.

[Pregnancy and labour in a patient after Fontan operation - a case report]. / Ciaza i poród u pacjentki po operacji metoda Fontana.

We present a case a 25-year-old pregnant female who had Fontan surgery performed 20 years ago due to a common ventricle of the left ventricular morphology. She had a history of three miscarriages and one successful pregnancy. This was a fifth pregnancy and she delivered normal healthy child. This is a second patient after Fontan procedure who had two successful deliveries. Clinical aspects of pregnancy in patients after Fontan procedure are described.