Inflammation in right ventricular dysfunction due to thromboembolic pulmonary hypertension

• Published in: International journal of cardiology 2010-10, Vol.144 (2), p.206-211
• Main Authors: von Haehling, Stephan, von Bardeleben, Ralph S, Kramm, Thorsten, Thiermann, Yardena, Niethammer, Margit, Doehner, Wolfram, Anker, Stefan D, Munzel, Thomas, Mayer, Eckhard, Genth-Zotz, Sabine
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomarkers; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Chronic thromboembolic pulmonary hypertension; Cytokines; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hypertension, Pulmonary - complications; Inflammation - etiology; Male; Medical sciences; Middle Aged; Pneumology; Pulmonary Embolism - complications; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Ventricular Dysfunction, Right - complications
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2009.04.019

Abstract Objectives and background Activation of the immune system is well established in patients with chronic heart failure (CHF) and impaired left ventricular function. High levels of pro-inflammatory cytokines are associated with a poor prognosis. Chronic thromboembolic pulmonary hypertension (CTEPH) frequently leads to impaired right ventricular function. It is not known whether such patients display chronic immune activation as well. Methods and results We studied 49 patients with CTEPH (50 ± 2 years, right ventricular ejection fraction [RVEF] 29 ± 2%, left ventricular ejection fraction [LVEF] 51 ± 3%, mean ± SEM) and compared their results with 17 patients with CHF (71 ± 2 years, LVEF 23 ± 1%) and 34 age-matched control subjects (age 57 ± 2 years). We studied serum levels of tumor necrosis factor-α (TNFα), its soluble receptors 1 and 2 (sTNFR1 and 2), interleukin-10 (IL-10) and plasma N-terminal-pro-B-type natriuretic peptide (NT-proBNP). Serum TNFα was not different in CTEPH compared with CHF patients ( p = 0.67) but both their levels were significantly higher than in controls (both p < 0.001). Similar results were obtained for sTNFR1, sTNFR2, and IL-10. Levels of NT-proBNP were not different in patients with CTEPH or CHF ( p = 0.54), but significantly higher than in control subjects (both p < 0.001). There were significant correlations between RVEF as assessed by magnetic resonance imaging and sTNFR1, sTNFR2, IL-6, high sensitivity C-reactive protein, and NT-proBNP (all p < 0.05) in patients with CTEPH. Conclusion Similar levels of immune activation as reflected by high levels of pro-inflammatory cytokines are present in patients with isolated right ventricular dysfunction due to CTEPH and patients with CHF and left ventricular dysfunction.