Neopterin and beta-2 microglobulin relations to immunity and inflammatory status in nonischemic dilated cardiomyopathy patients.

BACKGROUND: The aim of the study was to assess the relationships among serum neopterin (NPT), ß2-microglobulin (ß2-M) levels, clinical status, and endomyocardial biopsy results of dilated cardiomyopathy patients (DCM). METHODS: Serum NPT and ß-2 M were determined in 172 nonischaemic DCM patients who underwent right ventricular endomyocardial biopsy and 30 healthy subjects (ELISA test). The cryostat biopsy specimens were assessed using histology, immunohistology, and immunochemistry methods (HLA ABC, HLA DR expression, CD3 + lymphocytes, and macrophages counts). RESULTS: The strong increase of HLA ABC or HLA DR expression was detected in 27.2% patients-group A-being low in 72.8% patients-group B. Neopterin level was increased in patients in group A compared to healthy controls 8.11 (4.50-12.57) versus 4.99 (2.66-8.28) nmol/L (P < 0.05). ß-2 microglobulin level was higher in DCM groups A (2.60 (1.71-3.58)) and B (2.52 (1.51-3.72)) than in the control group 1.75 (1.28-1.96) mg/L, P < 0.001. Neopterin correlated positively with the number of macrophages in biopsy specimens (P < 0.05) acute phase proteins: C-reactive proteins (P < 0.05); fibrinogen (P < 0.01); and NYHA functional class (P < 0.05) and negatively with left ventricular ejection fraction (P < 0.05). CONCLUSIONS: Neopterin but not ß-2 microglobulin concentration reflected immune response in biopsy specimens. Neopterin correlated with acute phase proteins and stage of heart failure and may indicate a general immune and inflammatory activation in heart failure.

The relationship between late gadolinium enhancement imaging and myocardial biopsy in the evaluation of chronic heart failure patients with suspected myocarditis.

AIM: The aim of this study was to assess the relationship between late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) and immunohistochemical markers of inflammation in patients with heart failure and a reduced ejection fraction (HFrEF). MATERIAL AND METHODS: Endomyocardial biopsy and CMR were performed in 38 consecutive patients (24 males, average age 43.2 ± 6.9 years, New York Heart Association [NYHA] class II) with HFrEF and suspected myocarditis. The immunohistochemical evaluation was done by the En-Vision system using DAKO monoclonal antibodies. The presence of > 14 infiltrating cells together with myocardial damage and ≥ 2 + up-regulation of HLA class II was considered diagnostic for myocarditis. The results of LGE were compared with the immunohistochemical markers of inflammation. All patients underwent coronary angiography. RESULTS: Twelve out of 38 (31.6%) patients met the immunohistological criteria for the diagnosis of myocarditis. Late gadolinium enhancement was present in 23 of 38 (60.5%) patients, mostly at the interventricular septum. No correlation was found between LGE and immunohistochemistry results (Kendall's tau; r = 0.21, p = 0.09). CONCLUSIONS: Our study revealed no significant relationship between LGE cardiovascular magnetic resonance imaging and immunohistochemical markers of inflammation in patients with HFrEF.

Three­year survival of patients with chronic systolic heart failure due to hypertension: analysis of prognostic factors.

INTRODUCTION: Despite advances in medicine, chronic systolic heart failure (CHF) due to hypertension still constitutes a serious clinical challenge. OBJECTIVES: The aim of the study was to determine risk mortality factors in a 3-year follow-up of patients with CHF due to hypertension. PATIENTS AND METHODS: The study involved 140 consecutive stable inpatients with CHF (left ventricular end diastolic diameter >57 mm; left ventricular ejection fraction [LVEF] <40%), without epicardial artery stenosis (>30% vessel lumen), significant heart defect, diabetes, neoplastic, disease, or chronic kidney disease, with a minimum 5-year history of hypertension, and administration of angiotensin-converting enzyme inhibitors (or angiotensin II receptor antagonists), ß-adrenolytics, spironolactone and furosemide for 3 or more months. The follow-up began on admission to the hospital after laboratory tests, resting electrocardiogram and echocardiogram, six-minute walk test, coronarography, and endomyocardial biopsy. Late follow-up data was obtained from the follow-up visits or by telephone. RESULTS: The analysis involved 130 of 140 patients aged 47.8 ±7.9 years. The 3-year mortality rate was 18.5%. Independent risk factors for death were LVEF (hazard ratio [HR], 0.881; 95% confidence interval [CI], 0.797-0.975, P <0.05), serum glucose (HR, 1.266; 95% CI, 1.085-1.627; P <0.05), N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR, 1.369; 95% CI, 1.166-1.671; P <0.001), and bilirubin levels (HR, 1.057; 95% CI, 1.021-1.094; P <0.01). CONCLUSIONS: Beside LVEF and serum NT-proBNP, other independent risk factors for death in patients with CHF due to hypertension are glucose and bilirubin levels.

[Effect of elevated bilirubin levels on the long-term outcome in patients with chronic heart failure due to hypertension]. / Wplyw stqienia bilirubiny na rokowanie odlegle u pacjentów z przewlekla skurczowa niewydolnoscia serca w przebiegu choroby nadcisnieniowej.

OBJECTIVES: The aim of the study was to evaluate the occurence of death and major adverse cardiac events (MACE) in patients with normal (group A) and elevated (group B) plasma bilirubin levels. PATIENTS AND METHODS: We evaluated 124 patients (83% males, mean age 50.1 +/- 7.7 yrs) in New York Heart Association class II and III with hypertension-related chronic heart failure. We assessed the occurence of death and MACE (death, urgent heart transplantation and readmission to hospital). RESULTS: Groups A and B comprised 77 and 47 patients respectively. The independent predictors of death in group B were: N-terminal pro-brain natriuretic peptide (NT-proBNP) level (per 100 pg/ml difference; 95% CI: 1.29-4.76; p = 0.005) and physical component summary score (per 10 point difference; 95% CI: 0.66-0.99; p = 0.03). The independent predictors of MACE in group B were: age (per 10 yrs; 95% CI: 0.1-1.8; p = 0.04), NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.02-3.69; p = 0.04) and the symptoms of depression (95% CI: 1.02-2.5; p = 0.01). The independent predictors of MACE in group A were: NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.31-5.32; p = 0.006) and mental component summary (per 10 point difference; 95% CI: 0.85-0.98; p = 0.01). In a two-year follow-up the death rate was 5.2% in group A, and 23.4% in group B (p = 0.002) and frequency of MACE 18.2% and 42.6% in group A and B (p = 0.003), respectively. CONCLUSIONS: Elevated bilirubin levels are associated with higher incidence of death and MACE during a two-year follow-up in patients with hypertension-related chronic heart failure. Thus, it may be used as a simple prognostic factor in such of patients.

Assessment of right ventriclar function by tissue Doppler in relation to plasma NT-proBNP concentration in patients with dilated cardiomyopathy.

BACKGROUND: Impairment of right ventricular function is a common finding in patients with dilated cardiomyopathy (DCM). The aim of the study was to assess the function of the right ventricle by tissue Doppler imaging (TDI) in relation to NT-proBNP concentration in patients with DCM. METHODS: 29 patients with DCM were studied. Group I (n = 21) constituted of subjects with a NT-proBNP concentration > 500 pg/ml and group II (n = 8) constituted of patients with NT-proBNP < 500 pg/ml. In all patients the TDI parameters for the free-wall of the right ventricle were analysed: velocity of myocardium (VEL), strain (epsilon) and strain rate (SR). RESULTS: There were no significant differences between the two groups with respect to clinical characteristics, parameters of global and regional left ventricular systolic function or between indicators of global right ventricular function. In group I the maximal values of e in the apical and medial segments of the right ventricular free wall were significantly lower than in group II (-17 +/- 10 vs. -29 +/- 7%; p = 0.0168 and -13 +/- 6 vs. -25 +/- 5%; p = 0.0023 respectively). Moreover, in group I the maximal SR in the apical and medial segments of the right ventricular free wall were significantly lower than in group II (1.56 +/- 0.6 epsilon(-1) vs. -1.071 +/- 0.5 epsilon(-1); p = 0.0358 and -0.99 +/- 0.38 epsilon(-1) vs. -1.55 +/- 0.37 epsilon(-1); p = 0.0044 respectively). CONCLUSIONS: Impairment of right ventricular function is most visible in the apical and medial segments. The maximal values of e and SR for the right ventricle free wall are lower in patients with DCM and NT-proBNP > 500 pg/ml. (Cardiol J 2007; 14: 167-173).