Cytokines and LV Recovery in Recent Onset Cardiomyopathy

描述(由申请人提供)： 对于最近出现原发性扩张症的患者 心肌病，心肌炎症的存在可能提示 潜在的自限和可逆过程，以及急性 “心肌炎”实际上可能更有可能患上左心室 比那些患有更多慢性病的人更容易康复。的低敏感度 心内膜心肌活检限制了其临床应用，循环血浆 细胞因子可能是可逆性心肌梗死更敏感的指标 炎症过程。这项提案将调查这样一个假设，即 新近发病的扩张型心肌病患者血浆细胞因子的检测 帮助前瞻性地描述有更大可能性的心肌梗死患者 恢复。 特定目标1将评估基线血浆细胞因子水平的相关性 (肿瘤坏死因子、肿瘤坏死因子受体和白介素6)与超声心动图测量 心脏收缩和舒张期功能。这项研究将招收120名学生 新近发病的特发性扩张型心肌病或心肌炎患者 左心室射血分数小于等于0.40。这将对假设进行评估 新发心肌病患者血浆细胞因子是心脏疾病的标志物 炎症，并将与更深刻的心肌扰动相关 功能。 《特定目标2》将评估这样一种假设，即患有更多运动性疾病的患者 心肌炎(血浆较高的TNFa)出现时， 有可能在以下时间显著恢复左心室收缩功能 12个月随访。超声心动图检查将在6点和12点重复。 进入后的几个月。此外，我们还将评估这样的假设：患者 血浆IL-6水平越高，无事件存活率越低 随后的后续跟进。 特指目标3将探索细胞因子多态的假设 基因，特别是TNFa和IL-6启动子中的那些基因，将影响水平 它们各自的介体，并将随后影响临床 结果。

DESCRIPTION (provided by applicant): For patients presenting with the recent onset of primary dilated cardiomyopathy, the presence of myocardial inflammation may suggest a potentially self limited and reversible process, and patients with acute "myocarditis" may actually have a better probability of left ventricular recovery than those with more chronic disease. The poor sensitivity of endomyocardial biopsy has limited its clinical utility, and circulating plasma cytokines are potentially more sensitive indicators of a reversible myocardial inflammatory process. This proposal will investigate the hypothesis that the assessment of plasma cytokines in recent onset dilated cardiomyopathy, can help to prospectively delineate patients with greater likelihood of myocardial recovery. Specific Aim 1 will assess the correlation of baseline plasma cytokine levels (TNFa, TNF receptors, and IL-6) with echocardiographic measures of left ventricular systolic and diastolic function. The study will enroll 120 patients with recent onset idiopathic dilated cardiomyopathy or myocarditis with an LVEF less than or equal to 0.40. This will evaluate the hypothesis that plasma cytokines in recent onset cardiomyopathy are markers of cardiac inflammation and will correlate with more profound perturbations of myocardial function. Specific Aim 2 will evaluate the hypothesis that patients with more active myocardial inflammation (higher plasma TNFa) upon presentation, are more likely to have significant recovery of left ventricular systolic function at 12 month follow up. Echocardiographic assessment will be repeated at 6 and 12 months after entry. In addition we will evaluate the hypothesis that patients with higher plasma IL-6 levels will have a poorer event free survival during subsequent follow up. Specific Aim 3 will explore the hypothesis that polymorphisms of cytokine genes, in particular those in the TNFa and IL-6 promoters, will effect levels of their respective mediators, and will subsequently influence clinical outcomes.