Department of Internal Medicine, University of Florence, Florence, Italy.
Cardiol J. 2009;16(6):545-52.
The effect of cardiac resynchronization therapy (CRT) on systemic inflammation and neurohormonal alterations associated with heart failure is not well characterized. Accordingly, we aimed to assess the long term effects of CRT on systemic inflammation and neurohormonal factors in heart failure patients.
In 47 HF patients (NYHA III-IV) we evaluated, at baseline and after one year of CRT: TNF-alpha, TNF soluble receptors (sTNFR1 and sTNFR2), insulin-like growth factor-1alpha (IGF-1alpha), adiponectin, norepinephrine, pro-atrial natriuretic peptide (pro-ANP), N-terminal-pro-brain natriuretic peptide (NT-proBNP) and angiotensin II, NYHA functional class, quality of life (the Minnesota Living with Heart Failure questionnaire), a 6-minute walk test and an echocardiogram. Long-term CRT decreased activation of renin-angiotensin system (RAS) only in patients with reverse remodelling. It failed to prevent a decline in adiponectin levels, regardless of reverse remodelling. NT-proBNP remained unchanged in patients with reverse remodelling, whereas its levels increased in those without reverse remodelling. IGF-1alpha increased with CRT, whereas CRT had no effect on pro-ANP and inflammatory markers.
Long-term CRT is associated with decreased RAS activation and stabilization of NT-proBNP in heart failure patients with reverse remodelling. Long-term CRT, with or without reverse remodelling, does not affect systemic inflammation and fails to prevent a decline in adiponectin.
心脏再同步治疗（CRT）对心力衰竭相关的全身炎症和神经激素改变的影响尚不清楚。因此，我们旨在评估 CRT 对心力衰竭患者全身炎症和神经激素因素的长期影响。
我们在 47 例心力衰竭患者（NYHA III-IV 级）中评估了基线和 CRT 治疗 1 年后的以下指标：肿瘤坏死因子-α（TNF-α）、肿瘤坏死因子可溶性受体（sTNFR1 和 sTNFR2）、胰岛素样生长因子-1α（IGF-1α）、脂联素、去甲肾上腺素、前心房利钠肽（pro-ANP）、N 末端脑利钠肽前体（NT-proBNP）和血管紧张素 II、NYHA 心功能分级、生活质量（明尼苏达州心力衰竭生活质量问卷）、6 分钟步行试验和超声心动图。长期 CRT 仅在发生逆重构的患者中降低了肾素-血管紧张素系统（RAS）的激活。无论是否发生逆重构，它都无法阻止脂联素水平的下降。在发生逆重构的患者中，NT-proBNP 保持不变，而在没有发生逆重构的患者中，其水平增加。IGF-1α随着 CRT 而增加，而 CRT 对 pro-ANP 和炎症标志物没有影响。
长期 CRT 与心力衰竭患者发生逆重构时 RAS 激活的降低和 NT-proBNP 的稳定相关。长期 CRT 无论是否发生逆重构，都不会影响全身炎症，也无法阻止脂联素的下降。
