Heart Failure Clinic - Clinical Cardiology, Cardiothoracic and Vascular Department, San Raffaele University Hospital, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2013 Jan;14(1):49-56. doi: 10.2459/JCM.0b013e328345a1f6.
The aim of this study was to evaluate, according to functional response, the neuroendocrine and inflammatory status in patients with chronic heart failure before and after therapy with carvedilol.
Serum tumor necrosis factor-α (TNF-α) soluble receptors (sTNF-R1 and sTNF-R2), interleukin (IL)-10 and IL-18, chromogranin A (CgA) and brain natriuretic peptide (pro-BNP) were measured in 37 New York Heart Association class II to IV heart failure patients, at baseline and after 6 months of therapy with carvedilol. Patients were divided in two groups according to whether, following carvedilol, left-ventricular ejection fraction (LVEF) had increased by at least 5% (17 patients) or not (20 patients). Baseline LVEF was higher in nonresponders (38 ± 5 vs. 31 ± 7%, P = 0.002). In responders, LVEF increased from 31 ± 7 to 51 ± 7% (P < 0.0001), whereas in nonresponders it decreased from 38 ± 5 to 33 ± 7%, (P = 0.02). sTNF-R1 (P = 0.019) and sTNF-R2 (P = 0.025) increased in nonresponders, whereas they did not change in responders. After carvedilol, IL-10 was significantly higher in responders (P = 0.03). Conversely, no significant IL-18 and CgA changes were observed in either group. CgA was not significantly different between groups at baseline and after carvedilol in either group, whereas pro-BNP significantly increased in nonresponders (from 438 ± 582 to 1324 ± 1664 pg/ml, P = 0.04) and decreased in responders (from 848 ± 1221 to 420 ± 530 pg/ml, P = 0.08).
Increased inflammatory activation observed only in heart failure patients not improving left-ventricular function after carvedilol may indicate that inflammation, either as a direct cause or as a consequence, is associated with progressive ventricular dysfunction.
本研究旨在根据功能反应评估慢性心力衰竭患者在使用卡维地洛治疗前后的神经内分泌和炎症状态。
37 例纽约心脏协会（NYHA）心功能 II-IV 级心力衰竭患者在基线时和使用卡维地洛治疗 6 个月后，检测肿瘤坏死因子-α（TNF-α）可溶性受体（sTNF-R1 和 sTNF-R2）、白细胞介素（IL）-10 和 IL-18、嗜铬粒蛋白 A（CgA）和脑钠肽（pro-BNP）。根据卡维地洛治疗后左心室射血分数（LVEF）是否至少增加 5%（17 例）将患者分为两组：应答者和无应答者。无应答者的基线 LVEF 更高（38±5%对 31±7%，P=0.002）。在应答者中，LVEF 从 31±7%增加到 51±7%（P<0.0001），而在无应答者中则从 38±5%减少到 33±7%（P=0.02）。sTNF-R1（P=0.019）和 sTNF-R2（P=0.025）在无应答者中增加，而在应答者中则没有变化。在使用卡维地洛后，应答者的 IL-10 显著升高（P=0.03）。相反，两组的 IL-18 和 CgA 均无显著变化。在两组中，CgA 在基线和卡维地洛治疗后均无显著差异，而无应答者的 pro-BNP 显著升高（从 438±582 到 1324±1664 pg/ml，P=0.04），应答者则降低（从 848±1221 到 420±530 pg/ml，P=0.08）。
仅在卡维地洛治疗后左心室功能未改善的心力衰竭患者中观察到的炎症活性增加，可能表明炎症是心室功能进行性恶化的直接原因或后果。
