Inflammatory activation following interruption of long-term cardiac resynchronization therapy

Abstract

Previous observations suggest that cardiac resynchronization therapy (CRT) may exert an anti-inflammatory effect. The objective of this study was to evaluate the effect of temporary interruption of long-term CRT on plasma concentrations of proinflammatory cytokines and brain natriuretic peptide (BNP). The study group consisted of 54 patients (32 male and 22 female, mean age 64 years) with chronic heart failure (HF) treated with CRT. BNP, high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and neopterin were measured three times: after 26-28 weeks of continuous CRT (CRT-on), 48 h after its cessation (CRT-off), and 48 h after switching the CRT-on again. CRT interruption resulted in a significant worsening of left ventricular systolic function: reduction of cardiac output (CO), dP/dt, and left ventricular ejection fraction (LVEF), as well as deterioration of mitral regurgitation in the CRT responder group. A significant increase in serum concentrations of hs-CRP, neopterin, IL-6, and BNP was noted in this subpopulation. In CRT nonresponders, no significant changes were observed. In responders the changes in serum concentrations of hs-CRP, IL-6, neopterin, and BNP, following CRT interruption, significantly correlated with the respective changes in thoracic fluid content (TFC) and inversely correlated with LVEF changes. Even short (48 h) interruption of long-term CRT led to a significant increase of proinflammatory cytokines and BNP concentrations in responders. The changes in hs-CRP, IL-6, neopterin, and BNP concentrations correlated with the change in TFC-marker of pulmonary congestion and inversely correlated with the change in LVEF.

Effect of Cardiac Resynchronization Therapy on Inflammation in Congestive Heart Failure: A Review

“…However, trials with unchanged levels of CRP have also been reported . In an interesting study by Rubaj et al ., it was demonstrated that serum CRP increased if the CRT was inactivated for just 48 h, and then decreased again following reactivation of the pacemaker . The same pattern was seen for IL‐6.…”

“…Several small and medium‐sized trials have shown a reduction in inflammatory mediators when heart failure patients are treated with CRT . In some of the studies, this is true only for patients defined as responders by predefined criteria .…”

Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery

“…In clinical settings, cytokines including IL6 are acutely elevated during ST-or non-ST-elevation acute coronary syndromes (De Servi, et al, 2014;Neumann, et al, 1995). Markers of inflammation are also elevated in heart failure which can be reduced by cardiac resynchronization therapy (Rubaj, et al, 2013).…”

Usefulness of Elevated Urine Neopterin Levels in Assessing Cardiac Dysfunction and Exercise Ventilation Inefficiency in Patients With Chronic Systolic Heart Failure

“…Although in general natriuretic peptides and neopterin track with changes in myocardial function 22, 27 , dissociation in serum neopterin or inflammatory marker levels and B-type natriuretic peptide has been previously observed following improvements in hemodynamics following pacing therapy 28 . Our relatively stable ambulatory patient population with a relatively low range of natriuretic peptide levels may also dampen such association.…”