Pro-Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction.
Pro-Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction.
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DOI：
10.1161/jaha.117.007385
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发表时间：
2018-04-12
影响因子：
5.4
通讯作者：
LeWinter MM
中科院分区：
文献类型：
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作者：
Abernethy A;Raza S;Sun JL;Anstrom KJ;Tracy R;Steiner J;VanBuren P;LeWinter MM
射血分数保留性心力衰竭（HFpEF）中的潜在炎症已越来越多地被认识到。在本研究中，我们检验了急性失代偿性HFpEF（AD‐HFpEF）患者的促炎性生物标志物高于稳定性HFpEF（S‐HFpEF）患者的假设。使用事后分析，分析了入组NHLBI心力衰竭研究网络临床试验的HFpEF患者的血清生物标志物肿瘤坏死因子-α、高敏C反应蛋白白细胞介素6和正五聚蛋白3（PTX 3）以及临床、人口统计学、超声心动图-多普勒和临床结局数据，这些临床试验入组了AD-HFpEF或S-HFpEF患者。与S‐HFpEF相比，AD‐HFpEF患者的PTX 3水平更高（3.08 ng/mL vs 1.27 ng/mL，P<0.0001），白细胞介素-6（4.14 pg/mL vs 1.71 pg/mL，P<0.0001），肿瘤坏死因子-α（11.54 pg/mL vs 8.62 pg/mL，P=0.0015）和高敏C反应蛋白（11.90 mg/dL vs 3.42 mg/dL，P<0.0001）。此外，与前一年因失代偿性HF入院的S‐HFpEF患者相比，AD‐HFpEF患者的高敏C反应蛋白、白细胞介素6和PTX 3水平显著更高。PTX 3与左心房容积指数（r=0.41，P=0.0017）和左心室质量（r=0.26，P=0.0415）呈正相关，而肿瘤坏死因子-α与E/A比值呈负相关（r=-0.31，P=0.0395）。与S‐HFpEF患者相比，AD‐HFpEF患者的促炎生物标志物水平显著更高。PTX 3和肿瘤坏死因子-α与舒张功能障碍的超声心动图-多普勒证据相关。综上所述，这些数据支持这样的概念，即促炎状态升高在AD‐HFpEF的发生中具有病理生理作用。
Underlying inflammation has been increasingly recognized in heart failure with a preserved ejection fraction (HFpEF). In this study we tested the hypothesis that pro‐inflammatory biomarkers are elevated in patients with acutely decompensated HFpEF (AD‐HFpEF) compared with patients with stable HFpEF (S‐HFpEF). Using a post hoc analysis the serum biomarkers tumor necrosis factor‐alpha, high‐sensitivity C‐reactive protein interleukin 6 and pentraxin 3 (PTX3) and clinical, demographic, echocardiographic‐Doppler and clinical outcomes data were analyzed in HFpEF patients enrolled in NHLBI Heart Failure Research Network clinical trials which enrolled patients with either AD‐HFpEF or S‐HFpEF. Compared to S‐HFpEF, AD‐HFpEF patients had higher levels of PTX3 (3.08 ng/mL versus 1.27 ng/mL, P<0.0001), interleukin‐6 (4.14 pg/mL versus 1.71 pg/mL, P<0.0001), tumor necrosis factor‐alpha (11.54 pg/mL versus 8.62 pg/mL, P=0.0015), and high‐sensitivity C‐reactive protein (11.90 mg/dL versus 3.42 mg/dL, P<0.0001). Moreover, high‐sensitivity C‐reactive protein, interleukin‐6 and PTX3 levels were significantly higher in AD‐HFpEF compared with S‐HFpEF patients admitted for decompensated HF within the previous year. PTX3 was positively correlated with left atrial volume index (r=0.41, P=0.0017) and left ventricular mass (r=0.26, P=0.0415), while tumor necrosis factor‐alpha was inversely correlated with E/A ratio (r=−0.31, P=0.0395). Levels of pro‐inflammatory biomarkers are strikingly higher in AD‐HFpEF compared with S‐HFpEF patients. PTX3 and tumor necrosis factor‐alpha are correlated with echocardiographic‐Doppler evidence of diastolic dysfunction. Taken together these data support the concept that a heightened pro‐inflammatory state has a pathophysiologic role in the development of AD‐HFpEF.