Increased interleukin-13 levels in patients with chronic heart failure

A great number of basic and clinical studies have demonstrated that inflammatory cytokines play an important role in development and progress of heart failure. However, there is limited information about allergic cytokine interleukin-13 (IL-13). The inflammatory responses mediated by allergic cytokines can cause significant morbidity and mortality when they become chronic. Therefore, we elucidated the role of IL-13 in the pathophysiology of chronic heart failure. We measured plasma IL-13 levels by enzyme-linked immunosorbent assay in 110 patients with chronic heart failure and 20 control subjects. Plasma IL-13 levels were increased in heart failure patients, compared with the controls, in association with NYHA functional class. In addition, IL-13 levels were correlated positively with plasma levels of brain natriuretic peptide and C-reactive protein, and negatively with left ventricular ejection fraction. Plasma IL-13 levels may be useful for evaluating disease severity in chronic heart failure.     

The oxygen stress index and levels of circulating interleukin-10 and interleukin-6 in patients with chronic heart failure

OBJECTIVES: We sought to study circulating levels of pro- and anti-inflammatory cytokines together with the oxygen stress index in patients with chronic heart failure (CHF). BACKGROUND: Patients with CHF exhibit elevated levels of inflammatory and anti-inflammatory cytokines but the relative level of these cytokines with the oxygen stress index have not been reported. METHODS: Twenty-two patients with CHF and 10 control subjects were studied. Plasma levels of IL-6 and IL-10 were determined and the oxygen stress index was evaluated by urine 8-iso-PGF2alpha estimations. RESULTS: Plasma levels of IL-6 and IL-10 in CHF patients were significantly higher than those observed in the control subjects. Patients with more advanced disease (higher NYHA class) showed higher concentrations of IL-10 and IL-6 than those with less serious disease. 8-iso-PGF2alpha urine concentration (and therefore the oxygen stress index) was significantly higher in patients with CHF in comparison with control subjects. IL-6 plasma levels, but not IL-10 concentrations, correlated significantly with 8-iso-PGF2alpha levels in urine. CONCLUSIONS: Inflammatory and anti-inflammatory cytokine levels, as well as the oxidative stress index, are increased in patients with chronic heart failure. Inflammatory cytokine IL-6, but not anti-inflammatory cytokine Il-10, levels correlated significantly with the oxygen stress index.     

Short-term haemodynamic effects of dopexamine in patients with chronic congestive heart failure

Dopexamine (FPL 60278) is a new dopamine analogue which possessesa combination of dopamine receptor and beta-2-adrenoreceptoragonist properties. The aim of our study was to evaluate theshort-term haemodynamic effects of dopexamine administered byintravenous infusion at different dosage rates. Eight patientswith chronic congestive heart failure were studied. A dose of1 µg kg^–1 min^–1 produced a 27% decrease insystemic vascular resistance index (32.6 to 23.9 res. unitsm², P<0.001 and a significant increase in cardiac index (2.7to 3.61min^–1 m^–2, P<0.001). Stroke volume indexand heart rate increased significantly by 22% and 7%, respectively.An increase in left ventricular stroke work index was also seenat the dose level inducing the maximum cardiac output. Leftventricular filling pressures and arterial blood pressures werenot affected. We conclude that administration of dopexamineto patients with congestive heart failure augments cardiac performanceat rest.     

充血性心力衰竭患者血浆一氧化氮和内皮素等的改变

目的探讨充血性心力衰竭时血浆一氧化氮（ＮＯ）、内皮素（ＥＴ）的变化及前列腺素的影响。方法测定３５例充血性心力衰竭（心衰）患者血浆ＮＯＥＴ血管紧张素转换酶（ＡＣＥ）活性。２０例健康者作对照组。１５例患者静脉滴注前列腺素Ｅ１（ＰＧＥ１,２０～４０ｎｇ·ｋｇ－１·ｍｉｎ－１）,Ｓｗａｎｇａｎｚ导管监测血流动力学,用药前后测肺动脉、头静脉血浆ＮＯ、ＥＴ和ＡＣＥ活性。结果心衰患者存在肺动脉高压,心衰组血浆ＮＯ高于对照组,肺动脉血浆中高于自身静脉。心衰组血浆ＥＴ和ＡＣＥ活性呈相似改变。心衰组血浆ＥＴ的增幅大于ＮＯ,ＮＯ／ＥＴ比值下降。上述改变均与心衰严重程度有关（Ｐ＜０．０５）。前列腺素Ｅ１显著降低肺动脉压力,增加心脏指数,降低血浆ＮＯ、ＥＴ和ＡＣＥ水平,增加ＮＯ／ＥＴ比值。结论血浆ＮＯ水平增高是心力衰竭病理生理特征之一。ＮＯ、ＥＴ与ＮＯ／ＥＴ等改变与肺动脉高压和局部血管内皮细胞损伤有关,参与心衰的病理生理。前列腺素Ｅ１可以抑制上述改变。     

不同病因慢性心力衰竭患者血浆apelin浓度比较

目的：检测不同基础心脏病所致慢性心力衰竭（CHF）患者的血浆apelin浓度。方法：按照纽约心脏病协会（NYHA）心功能分级标准和左室射血分数（LVEF〈50％）选择68例心功能不全患者为心衰组,选择心功能正常者21例做对照组·应用酶联免疫吸附法（ELISA）检测血浆apelin水平,比较不同病因如高血压病、冠心病、扩张性心肌病所致心衰的血浆apelin浓度区别。结果：CHF组血浆apelin水平高于对照组[（5．07±0．75）ng／ml：（3.73±0．3）ng／ml,P〈0．01];不同病因心衰血浆apelin含量无显著差别（P〉0．05）。结论：CHF患者血浆apelin浓度高于心功能正常者,可考虑将apelin浓度检测作为心力衰竭患者筛查诊断指标之一。     

Decreased heart rate recovery in patients with heart failure: effect of fluvastatin therapy

Heart rate recovery is the difference in heart rate at peak exercise and at a specific time interval following the onset of recovery. Attenuated heart rate recovery is an independent predictor of mortality in patients with a history of coronary artery disease. The aim of the present study was to evaluate the effect of a statin on heart rate recovery, particularly in patients with ischemic heart failure and hyperlipidemia. Twenty-nine consecutive hyperlipidemic, stable coronary artery disease patients with heart failure and 19 healthy subjects were enrolled. Heart rate recovery values at the 1st and 3rd minutes and lipid profiles of the patients were evaluated at baseline and following 3 months of treatment with fluvastatin. Compared with healthy subjects, the heart rate recovery values were significantly lower in the heart failure patients in both the 1st and 3rd minutes, respectively (31 +/- 6 versus 19 +/- 7, P < 0.0001; 66 +/- 7 versus 47 +/- 8, P < 0.0001). Heart rate recovery in the 1st and 3rd minutes increased from 19 +/- 7 to 24 +/- 9 and 47 +/- 8 to 57 +/- 11, respectively, following treatment (P < 0.001, P < 0.001). There were no significant correlations among the changes in lipid parameters or HRR in the first and third minutes in the recovery period. The results revealed an improvement in heart rate recovery in heart failure patients by fluvastatin treatment. If this association can be confirmed by other studies, it would be interesting to perform further studies into the mechanism underlying this finding.     

Short-term effects of cardiac resynchronization therapy on sleep-disordered breathing in patients with systolic heart failure

OBJECTIVES: We evaluated the short-term effect of cardiac resynchronization therapy (CRT) on sleep apnea in patients with systolic heart failure. BACKGROUND: Sleep-disordered breathing is common in patients with left ventricular systolic dysfunction. METHODS: Twelve patients (mean [+/-SE] age, 59.6+/-7.8 years; mean left ventricular ejection fraction, 28.0+/-2.8%) with an implanted atrial-synchronized biventricular pacemaker for the treatment of left ventricular systolic dysfunction were selected and studied. Each subject underwent polysomnography on 3 consecutive nights with CRT on the first night, CRT off the second night, and CRT on the third night. Echocardiography was performed prior to each polysomnogram. RESULTS: The central sleep event index (ie, the number of central sleep apneas [CSAs] and hypopneas per hour of sleep) score was lower with CRT compared to that without CRT (mean central sleep event index score with CRT on, 6.9+/-1.7 events per hour of sleep; mean central sleep event index score with CRT off, 14.3+/-2.9 events per hour of sleep; mean central sleep event index score with CRT on, 8.1+/-1.5 events per hour of sleep; p<0.001). Similarly, the cumulative duration of central sleep events (the number of minutes per hour of sleep during CRT) was one half that observed without CRT (CRT on, 2.8+/-0.7 min per hour of sleep; CRT OFF 6.2+/-1.2 min per hour of sleep; CRT ON 3.1+/-0.7 min per hour of sleep; p<0.001). There was a significant correlation between mitral regurgitant volume and central sleep event index on all three nights (r>or=0.77; p<0.01). CONCLUSIONS: CRT reduces CSA severity in the short term. This reduction correlated significantly with the CRT-mediated reduction of mitral regurgitation.     

Beneficial effects of carvedilol on angiotensin-converting enzyme activity and renin plasma levels in patients with chronic heart failure

OBJECTIVE: To assess the effects of carvedilol treatment on the renin-angiotensin system in patients with chronic heart failure (CHF). Background: Carvedilol improves survival of patients suffering from CHF but the effects of the drug on angiotensin-converting enzyme (ACE) activity, renin and aldosterone are not well characterized in patients receiving an ACE inhibitor. METHODS: A randomized, multicenter, double-blind, 6-month, placebo-controlled study of carvedilol vs. placebo was conducted in 64 CHF patients. Circulating levels of ACE activity, active renin and aldosterone as well as left ventricular diameters and ejection fraction by echography were assessed. RESULTS: During the study, left ventricular ejection fraction increased from 25+/-11% to 31+/-12% with carvedilol and from 27+/-12% to 28+/-12% with placebo (P=0.03). This beneficial effect was associated with marked blunting of active renin secretion (-53% in the carvedilol group vs.-13% in the placebo group, P=0.04). ACE activity was reduced by 30% in the carvedilol group (P=0.07 vs. placebo). Aldosterone was not changed. CONCLUSION: Carvedilol markedly reduced the increase in active renin observed with time despite ACE-inhibitors and tended to decrease ACE activity. These findings may in part explain the beneficial actions of carvedilol and highlights the profound effect of betablockade on renin in patients already receiving ACE-inibitors.     

慢性心力衰竭患者血浆利钠肽水平的变化

目的 :研究慢性心力衰竭 (CHF)患者血浆利钠肽 (ANP、BNP、CNP)水平的变化及其与心功能状态、心脏结构的关系 ,探讨其用于CHF诊断的价值。方法 :4 8例CHF患者为心力衰竭组 ,心功能按HYHA标准分级 :Ⅱ级 15例 ,Ⅲ级 2 4例 ,Ⅳ级 9例 ,基本病因为冠心病、扩张型心肌病、高血压性心脏病 ;对照组 10例 ,为健康体检者。用同位素放射免疫法和免疫放射法测定血浆ANP、BNP、CNP水平 ,心脏彩色多普勒超声诊断仪测量左室结构和功能。结果 :心力衰竭组血浆ANP、BNP水平均较对照组显著增高(P均 <0 0 1) ,并与心功能严重程度有关 ,但不同病因的CHF患者之间血浆ANP、BNP、CNP水平均无明显差异 (P均 >0 0 5 )。其中LVEF <4 5 %的患者 4 1例 ,其血浆BNP水平和LVEF负相关 (r=- 0 37,P <0 0 5 ) ,和左室舒张末期内径 (LVEDD)、左室心肌重量指数 (LVMI)呈正相关 (r均为 0 36 ,P均 <0 0 5 ) ,血浆ANP、BNP水平和肺动脉收缩压正相关 (P <0 0 5或P <0 0 1)。血浆CNP水平在CHF患者无明显升高 (P >0 0 5 )。结论 :血浆ANP、BNP水平可作为反映心功能状态的指标 ,其中血浆BNP水平更为敏感、特异并且和心脏结构相关 ,可作为CHF诊断及鉴别诊断的指标     

慢性肾衰竭合并冠心病患者血浆氧化型低密度脂蛋白水平变化及临床意义

目的 探讨慢性肾衰竭(CRF)合并冠心病患者血浆氧化型低密度脂蛋白(ox-LDL)水平变化及临床意义.方法 用ELISA方法测定299例住院病人和111例健康自愿者血浆ox-LDL水平,同时测定血浆TC、TG、HDL-C、LDL-C、Scr与ALB指标.结果 血浆ox-LDL水平:CRF合并冠心病组[n=148,(430.88±190.56) μg/dl]明显高于非合并冠心病组[n=72,(139.13±50.15) μg/dl](P<0.05);CRF合并不稳定性心绞痛组[n=66,(545.58±202.89) μg/dl]明显高于合并稳定性心绞痛组[n=82,(255.75±112.3) μg/dl](P<0.05).CRF组[n=220,(372.18±153.68) μg/dl]明显高于正常对照组[n=111,(34.90±17.65) μg/dl]与慢性肾炎组[n=79,(40.64±20.20) μg/dl](P<0.05);但慢性肾炎组与正常对照组无显著性差异(P>0.05).结论 CRF患者血浆ox-LDL水平显著高于正常人及慢性肾炎患者,并发冠心病的患者其血浆ox-LDL水平升高更为明显,其中合并不稳定性心绞痛患者血浆ox-LDL水平尤其高.因此,CRF患者血浆ox-LDL浓度的高低可间接提示动脉粥样硬化的存在及严重程度.     

Plasma myeloperoxidase levels in patients with chronic heart failure

Increased oxidative stress and endothelial dysfunction are commonly observed in patients with chronic heart failure (HF). The relation between myeloperoxidase (MPO), an inflammatory marker with mechanistic links to plaque vulnerability and abnormal ventricular remodeling, and degrees of severity in chronic HF has not been reported. Plasma MPO levels were measured in 105 normal controls (no history of HF or left ventricular dysfunction) and 102 patients with chronic systolic HF (left ventricular ejection fraction <50%), and the relations among plasma MPO levels, plasma B-type natriuretic peptide levels, and the left ventricular ejection fraction were examined. Plasma MPO levels in patients with chronic systolic HF were significantly elevated compared with those of healthy controls (1,158 +/- 2,965 vs 204 +/- 139 pM, p <0.0001). Plasma MPO levels increased in parallel with increasing New York Heart Association class (p <0.0001) and were correlated with plasma B-type natriuretic peptide levels (Spearman's r = 0.39, p <0.0001). Levels of MPO were strongly associated with the prevalence of HF (unadjusted odds ratio 30.3, 95% confidence interval 11.1 to 94.5) and remained significant when adjusted for age and B-type natriuretic peptide (odds ratio 27.7, 95% confidence interval 3.6 to 371.1). In conclusion, in a cohort of patients with chronic HF, plasma MPO levels were elevated compared with those of normal controls and were associated with worsening functional class.     

Tumour marker levels in patients with chronic heart failure

BACKGROUND: Carbohydrate Antigen 125 (CA 125), a marker for ovarian cancer has been reported to increase in relation to the severity of heart failure. OBJECTIVE: To evaluate the serum levels of CA 125 and other tumour markers, in patients with chronic heart failure. METHODS: Blood levels of CA 125 and other tumour markers were determined in 44 heart failure patients (16 males and 28 females; age 66.3+/-6.5 years) before and after optimal medical treatment. Levels were also evaluated in 30 healthy volunteers (11 males and 19 females; age 65.7+/-9.8 years). The results in the heart failure patients were grouped according to clinical status (New York Heart Association Class). The mean duration of follow-up was 3+/-1.5 months. RESULTS: The mean serum level of CA 125 was 81.9+/-91 in the patient group and 7.5+/-4.8 in control group (p<0.001). The mean CA 19-9 level in the patient group (16.8+/-16.6) was significantly higher than in the control group (4.5+/-2.6) (p<0.001). CA 125 levels increased as the New York Heart Association (NYHA) functional class increased (Class I/II: 17.7+/-22.4 U/ml; Class III: 99.6+/-92.1 U/ml; Class IV 136.4+/-102.8 U/ml; p<0.05). There were no significant differences in serum CA 125 and other tumour marker levels before and after optimisation of treatment. Significantly higher serum CA 125 levels were found in patients with pericardial effusion (p=0.002) when compared to patients without pericardial effusion. CONCLUSION: Among the tumour markers evaluated, only CA 125 seems to be specifically related to the presence and severity of heart failure and also the presence of pericardial fluid. Therefore, measurements of CA 125 serum levels might be proposed for the serial assessment of heart failure. Whether CA 125 has a specific biological role in heart failure requires further investigation.     

慢性心力衰竭患者血浆脑钠肽和内皮素-1水平与血流动力学的相关性

目的:探讨慢性心力衰竭(HF)患者血浆脑钠肽(BNP)、内皮素-1(ET-1)水平与血流动力学的相关性及其临床意义。方法:2004年3月~2005年5月住院慢性HF患者75例,行Swan-Ganz导管检查53例,用干式快速免疫荧光法定量和放射免疫法分别检测血浆BNP、ET-1水平,超声心动图检查左室舒张末期内径(LVEDD)。结果:随着NYHA心功能级别增加,肺毛细血管嵌压(PCWP)、平均肺动脉压(MPAP)、右房压(RAP)和血浆BNP、ET-1水平均显著升高(P<0.01)。血浆BNP、ET-1分别与PCWP、MPAP、RAP呈显著正相关(P<0.01)。多元线性回归提示ET-1水平为影响血浆BNP浓度的独立因素(标准化偏回归系数为0.28,P<0.01)。LVEDD≥60mm组(31例)血浆BNP和ET-1浓度分别为(968.23±478.63)、(129.45±88.56)ng·L-1,显著高于LVEDD<60mm组(44例)[(286.26±156.89)、(87.45±43.65)ng·L-1],P<0.01。结论:慢性HF患者BNP、ET-1水平与PCWP、MPAP、RAP显著正相关,BNP的释放直接与心室压力负荷过度和心室容积扩张相关,BNP是反映心室受损敏感指标,ET-1可刺激HF心室BNP的分泌。     

Short-term effects of levosimendan and prostaglandin E1 on hemodynamic parameters and B-type natriuretic peptide levels in patients with decompensated chronic heart failure

BACKGROUND: Both levosimendan and prostaglandin E1 (PGE1) have beneficial effects on hemodynamic parameters and outcome compared to dobutamine in decompensated chronic heart failure (CHF). AIMS: We compared short-term effects of levosimendan versus PGE1 on hemodynamic parameters and B-type natriuretic peptide levels (BNP) in patients with decompensated CHF. METHODS AND RESULTS: 73 patients (cardiac index < 2.5 L/min/m2, pulmonary capillary wedge pressure (PCP) >15 mmHg) with decompensated CHF were randomised to treatment with either a 24 h-infusion of levosimendan (n=38) or a chronic infusion of PGE1 (n = 35). Hemodynamic parameters and BNP were measured at baseline, 24 and 48 h, BNP levels were also measured after 1 week. Baseline characteristics including concomitant medication were similar in both groups. Levosimendan and PGE1 increased cardiac output (CO) after 24 and 48 h. Levosimendan increased CO twice as much as PGE1 (24 h: Levosimendan +1.1 +/- 0.1 L/min, PGE1 +0.6 +/- 0.1 L/min, p < 0.001). Both drugs produced a comparable reduction in PCP and pulmonary artery pressure after 24 and 48 h. Levosimendan decreased BNP by 28% after 24 h and 22% after 48 h, but effects disappeared after 1 week. In contrast, PGE1 decreased BNP by 15% after 48 h (no change at 24 h), but a decrease of 20% was sustained at 1 week. CONCLUSIONS: The differential beneficial effects of levosimendan (greater increase in CO) and PGE1 (sustained decrease in BNP) may have a potential impact on clinical outcome.     

双室再同步起搏治疗充血性心力衰竭近期疗效

目的本研究旨在观察双室再同步起搏治疗严重的充血性心力衰竭疗效. 方法2001年4月～2002年11月在我科住院病人10例,男8例,女2例,年龄42～74岁,其中缺血性心肌病5例,扩张型心肌病4例,酒精性心肌病1例.     

Short-term effect of levosimendan on free light chain kappa and lambda levels in patients with decompensated chronic heart failure

To investigate the effects of levosimendan, a positive inotropic agent, on the new heart failure markers immunoglobulin free light chains kappa and lambda (FLC-κ and FLC-λ) in decompensated chronic heart failure (HF), 59 patients with New York Heart Association (NYHA) class III–IV HF were enrolled. Patients were randomized into levosimendan (n = 31) and standard HF treatment (n = 29) groups. Serum FLC-κ and FLC-λ, brain natriuretic peptide (BNP), and ejection fraction (EF) were measured before treatment and on the 5th day of treatment initiation. Forty-two percent of subjects were females (n = 25) and overall mean age was 64.1 ± 10.7 years. FLC-κ (P < 0.05) and FLC-λ (P < 0.05) were significantly decreased in the levosimendan group compared to baseline, but no difference in either marker in the standard treatment group was observed. Pre- and post-treatment FLC-κ/FLC-λ ratios in both groups were similar, whereas FLC-κ and FLC-λ levels and the FLC-κ/FLC-λ ratio showed no significant correlation with NYHA class, brain natriuretic peptide (BNP) and ejection fraction (EF) levels; and BNP and EF changes after the treatment. Symptomatic improvement in the levosimendan group according to the NYHA class was significantly better than in the standard treatment group (P = 0.044). While 55.2% of patients in the levosimendan group showed a 1-degree shift to lower NYHA classes, 10.3% showed a 2-degree decrease. In conclusion, levosimendan caused short-term hemodynamic and symptomatic improvements, with a more pronounced decrease in FLC levels in patients with advanced decompensated HF.     

心力衰竭心脏再同步治疗

慢性心力衰竭的传统治疗为药物治疗，随着血管紧张素转化酶抑制剂、血管紧张素受体拮抗剂、β受体阻滞剂和醛固酮受体拮抗剂的广泛应用，心力衰竭患者的心功能有所改善，但其病死率仍居高不下。有文献报道，心力衰竭患者5年存活率与恶性肿瘤相似。近年来心力衰竭的非药物治疗，尤其是心脏再同步治疗（CRT）应用于中至重度患者，     

氟伐他汀对慢性充血性心力衰竭患者凝血指标的影响

目的探讨慢性充血性心力衰竭(CHF)患者凝血指标的变化,观察氟伐他汀对其影响。方法70例CHF患者为实验组,随机分为A组(常规治疗组)35例,B组(常规治疗+氟伐他汀)35例,20例健康者为C组(对照组)。治疗前和治疗后2周分别检测血浆P-选择素(P-selectin)、D-二聚体(D-D)、血管性血友病因子(v-WF)水平。结果CHF患者血浆P-selectin、D-D、v-WF水平显著高于对照组(P<0.05)。A、B两组治疗2周后血浆P-selectin、D-D、v-WF水平均有不同程度下降,与治疗前比较有显著性差异(P<0.05);但两组间比较B组降低更明显(P<0.05)。结论CHF患者存在血栓前状态,氟伐他汀能改善CHF患者的高凝状态。