Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response

Almeida-Morais, Luís; Abreu, Ana; Oliveira, Mário; Cunha, Pedro Silva; Rodrigues, Inês; Portugal, Guilherme; Rio, Pedro; Soares, Rui; Carmo, Miguel Mota; Ferreira, Rui Cruz

doi:10.1016/j.repc.2017.06.017

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…A close association of cytokine levels with the severity of clinical manifestations of CHF has been revealed [17]. The association of the effectiveness of CRT with a decrease in immune activation has been established [9], which is confirmed by the results of our study -a significant decrease in IL-1β, IL-6, IL-10, TNF-α was detected in the group of responders. We did not reveal any significant dynamics of CRP in the studied groups.…”

Section: Discussionsupporting

confidence: 85%

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Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Кузнецов

Enina

Солдатова

et al. 2021

Vestnik aritmologii

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Purpose. To design a mathematical model, that can predict a positive response to cardiac resynchronization therapy (CRT) in patients with congestive heart failure (CHF) and sinus rhythm, according to complex analysis of neurohumoral and immune activation biomarkers, fibrosis, renal dysfunction, echocardiography.Methods. Parameters of echocardiography, plasma levels of NT-proBNP, interleukins-1β, 6, 10, tumor necrosis factor α, С-reactive protein (СRP), matrix metalloproteinase-9 (ММР-9), tissue inhibitors of metalloproteinase 1 and 4, cystatin С (CYSTATIN) were studied in 40 CHF patients with sinus rhythm (65% coronary artery disease patients, 75% males, mean age 54.8±10.6 years old) during the period of maximum decrease of left ventricular end-systolic volume (LVESV) (mean duration 27.5 [11.1; 46.3] months). Responders (decrease in LVESV ≥15%) and non-responders (decrease in LVESV <15%) were identified.Results. The number of responders was 26 (65%). The initial set of variables included: age, left ventricular ejection fraction (EF), pulmonary artery systolic pressure, right ventricle size and NT-proBNP, СRP, ММР-9, CYSTATIN. According to logistic regression analysis, a prediction model of positive CRT response was created. The specificity of the model was 92.9%, sensitivity - 83.3%, AUC=0.952 (р˂0.001).Conclusion. The proposed model, based on the assessment of left ventricle EF and circulating biomarkers of inflammation, fibrosis, and renal function, strongly suggests a higher possibility of response to CRT.

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Section: Discussionsupporting

confidence: 85%

“…The molecular mechanisms of CRT influence are being actively studied. The association of cardiac remodeling in connection with CRT with a decrease in the activity of immune inflammation, neurohumoral activation, and fibrosis has been established [9][10][11]. However, none of the studied biomarkers can predict a positive response to CRT.…”

mentioning

confidence: 99%

Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Кузнецов

Enina

Солдатова

et al. 2021

Vestnik aritmologii

View full text Add to dashboard Cite

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“…Hoogslag et al investigated the agreement between these different criteria, and found that NT-proBNP reduction was more frequently correlated with echocardiographic improvement, but not with clinical response [11]. By contrast, another prospective study showed no significant BNP reduction in the group of patients with echocardiographic response [12]. However, there was a significant association between functional response determined by cardiopulmonary exercise tests and BNP reduction [12].…”

Section: Markers Of Myocyte Stressmentioning

confidence: 99%

Updated insights into predictive biomarkers for response to cardiac resynchronization therapy - A literature review

Pal,

Cotoi,

Vlad

et al. 2023

Revista Romana De Medicina De Laborator

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Cardiac resynchronization therapy (CRT) was shown to greatly improve outcomes in specific patients with heart failure, low ejection fraction and wide QRS complex; however post-therapeutic response is heterogeneous and currently difficult to predict. There is an increasing interest in identifying humoral biomarkers which could help stratify prognosis, and better identify responders. The aim of this review was to provide an overview of recent data regarding the predictive value of biomarkers for evaluating response to CRT. A definitive conclusion cannot currently be drawn due to disparate results, varying methodologies, relatively small-scale studies and lack of consensus in defining CRT response. More extensive comparable research is paramount to facilitate progress in this field.

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“…Cardiac resynchronization therapy (CRT) is an effective treatment for patients with severe CHF. Based on biventricular pacing, CRT restores the electromechanical desynchrony of the heart, improving LV systolic function and reducing patient symptoms, re-hospitalizations and mortality [ 4 , 17 , 18 ]. Limited evidence suggests that CRT can reduce inflammatory mediators in HF patients [ 19 ], but the association between CRT response, T cells and cardiac remodeling in CHF is far from being understood [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Reduced numbers of regulatory T cells in chronic heart failure seems not to be restored by cardiac resynchronization therapy

Martins

António

Carvalheiro

et al. 2023

BMC Cardiovasc Disord

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Background T cells have been implicated in the development and progression of inflammatory processes in chronic heart failure (CHF). Cardiac resynchronization therapy (CRT) has beneficial effects on symptoms and cardiac remodeling in CHF. However, its impact on the inflammatory immune response remains controversial. We aimed to study the impact of CRT on T cells in heart failure (HF) patients. Methods Thirty-nine HF patients were evaluated before CRT (T0) and six months later (T6). Quantification of T cells, their subsets, and their functional characterization, after in vitro stimulation, were evaluated by flow cytometry. Results T regulatory (Treg) cells were decreased in CHF patients (healthy group (HG): 1.08 ± 0.50 versus (heart failure patients (HFP)-T0: 0.69 ± 0.40, P = 0.022) and remaining diminished after CRT (HFP-T6: 0.61 ± 0.29, P = 0.003). Responders (R) to CRT presented a higher frequency of T cytotoxic (Tc) cells producing IL-2 at T0 compared with non-responders (NR) (R: 36.52 ± 12.55 versus NR: 24.71 ± 11.66, P = 0.006). After CRT, HF patients presented a higher percentage of Tc cells expressing TNF-α and IFN-γ (HG: 44.50 ± 16.62 versus R: 61.47 ± 20.54, P = 0.014; and HG: 40.62 ± 15.36 versus R: 52.39 ± 18.66, P = 0.049, respectively). Conclusion The dynamic of different functional T cell subpopulations is significantly altered in CHF, which results in an exacerbated pro-inflammatory response. Even after CRT, it seems that the inflammatory condition underlying CHF continues to evolve with the progression of the disease. This could be due, at least in part, to the inability to restore Treg cells levels. Trial registration: Observational and prospective study with no trial registration.

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Impact of cardiac resynchronization therapy on inflammatory biomarkers and cardiac remodeling: The paradox of functional and echocardiographic response

Cited by 7 publications

References 28 publications

Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Updated insights into predictive biomarkers for response to cardiac resynchronization therapy - A literature review

Reduced numbers of regulatory T cells in chronic heart failure seems not to be restored by cardiac resynchronization therapy

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