Cytokines and LV Recovery in Recent Onset Cardiomyopathy

描述（由申请人提供）： 对于近期出现原发性扩张性 心肌炎，心肌炎症的存在可能表明 潜在的自限性和可逆性过程，以及急性 “心肌炎”实际上可能有一个更好的概率左心室 比那些有更多慢性疾病的人更容易康复。敏感性差， 肌内膜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的更敏感的指标， 炎症过程。这一提议将调查的假设， 评估近期发作的扩张型心肌病患者的血浆细胞因子， 有助于前瞻性地描绘心肌梗死可能性更大患者 复苏 具体目标1将评估基线血浆细胞因子水平的相关性 (TNFa，TNF受体和IL-6）与超声心动图测量左心室 心室收缩和舒张功能。该研究将招募120名 近期发作的特发性扩张型心肌病或心肌炎患者 LVEF小于等于0.40这将评估假设 新近发病心肌病患者的血浆细胞因子是心脏 炎症，并将与更深刻的心肌扰动 功能 具体目标2将评估以下假设： 心肌炎症（较高的血浆TNF α）在表现时， 左心室收缩功能可能显著恢复， 12个月随访。将在6和12时重复超声心动图评估 进入后的几个月。此外，我们将评估患者 血浆IL-6水平越高， 后续跟进。 具体目标3将探讨细胞因子的多态性 基因，特别是TNF α和IL-6启动子中的基因，将影响TNF α和IL-6的表达水平。 它们各自的介质，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.