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European Heart Journal 2001 22(24):2275-2283; doi:10.1053/euhj.2001.2693
Copyright © 2001 by the European Society of Cardiology.
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Ventricular assist device in severe heart failure. Effects on cytokines, complement and body weight

A.L. Clarka,f1, M. Loebeb, E.V. Potapovb, K. Egererc, C. Knosallab, R. Hetzerb and S.D. Ankerc,d

a Department of Academic Cardiology, Castle Hill Hospital, Cottingham, Hull, U.K.
b Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
c Franz-Volhard-Klinik (Charité, Berlin-Buch) at MDC Berlin, Germany
d Department of Cardiac Medicine, National Heart and Lung Institute, London, U.K.

revised March 6, 2001; accepted March 14, 2001

Abstract

Aims Inflammatory and immune activation and body wasting are important features of end-stage chronic heart failure. It is not known whether restoration of cardiac output by assist device implantation can improve these abnormalities.

Methods We studied 48 patients (39 males; age 45±2 years) with NYHA class IV heart failure. All patients underwent ventricular assist device implantation for end-stage heart failure as a bridge to cardiac transplantation. Plasma levels of tumour necrosis factor {alpha}, and its receptors, interleukin-6, elastase, activated complement, and soluble CD14 receptors were measured at the time of operation and in survivors at 1 week (n=46), 40 days (n=35) and 90 days (n=26). Follow-up was for a minimum of 1 year.

Results One-year survival was 35% (95% CI: 22–49%). Body mass index was the only predictor of survival (body mass index >25 (n=16); survival 63 (39–86)%; body mass index <25 (n=32); survival 22 (7·5–36)%: P=0·003). Tumour necrosis factor {alpha} fell from 9·66±1·33pg.ml–1to 4·2±1·0 at 1 week (P=0·008), but returned to pre-operative levels at 90 days. Interleukin-6, activated complement and elastase fell progressively to 40 days, but were rising at 90 days. There was no change in tumour necrosis factor receptor. There was a gradual rise in CD14 (3·99±0·15µg.ml–1at baseline, 5·02±0·39 at 90 days, P=0·006). After surgery, body weight fell from 80±2 to 73±2kg by 1 month (P<0·001) and to 72±2kg at 90 days.

Conclusions Ventricular assist device implantation results in a short-term fall in tumour necrosis factor {alpha} and interleukin-6, but no change in CD14 or tumour necrosis factor receptor, suggesting that the pathophysiological process resulting in inflammation was not altered by left ventricular assist device implantation. Low body mass index is related to poor outcome after assist device implantation, and no weight gain.

Key Words: Chronic heart failure, ventricular assist device, cytokines, tumour necrosis factor {alpha}

f1 Correspondence: Dr A. L. Clark, Department of Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull, HU16 5JQ, U.K.

References

  1. Levine B, Kalman J, Mayer L, Fillit HM, Packer M. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med. 1990;323:236–241[Abstract]
  2. Anker SD, Chua TP. Hormonal changes and catabolic/anabolic imbalance in chronic heart failure: The importance for cardiac cachexia. Circulation. 1997;96:526–534[Abstract/Free Full Text]
  3. Anker S, Ponikowski P, Varney S. Wasting as an independent risk factor for mortality in chronic heart failure. Lancet. 1997;349:1050–1053[CrossRef][ISI][Medline]
  4. Torre-Amione G, Kapadia S, Lee J. Tumor necrosis factor-{alpha} and tumor necrosis factor receptors in the failing human heart. Circulation. 1996;93:704–711[Abstract/Free Full Text]
  5. Bryant D, Becker L, Richardson J. Cardiac failure in transgenic mice with myocardial expression of tumour necrosis factor-{alpha}. Circulation. 1998;97:1375–1381[Abstract/Free Full Text]
  6. Kubota T, McTiernan CF, Frye CS. Dilated cardiomyopathy in transgenic mice with cardiac-specific overexpression of tumour necrosis factor-{alpha}. Circ Res. 1997;81:627–635[Abstract/Free Full Text]
  7. Anker SD, Egerer K, Volk H-D, Kox WJ, Poole-Wilson PA, Coats AJS. Elevated soluble CD14 receptors and and altert cytokines in chronic heart failure. Am J Cardiol. 1997;79:1426–1430[CrossRef][ISI][Medline]
  8. Niebauer J, Volk HD, Kemp M. Endotoxin and immune activation in chronic heart failure: a prospective cohort study. Lancet. 1999;353:1838–1842[CrossRef][ISI][Medline]
  9. Ziegler-Heitbrock, Ulevitch RJ. CD14: Cell surface receptor and differentiation marker. Immunol Today. 1993;14:121–125[CrossRef][ISI][Medline]
  10. Shapiro SD. Elastolytic metalloproteinases produced by human mononuclear phagocytes. Potential roles in destructive lung disease. Am J Respir Crit Care Med. 1994;150:S160–164[ISI][Medline]
  11. Rosen GM, Pou S, Ramos CL, Cohen MS, Britigan BE. Free radicals and phagocytic cells. FASEB J. 1995;9:200–209[Abstract]
  12. McCarthy PM, Portner PM, Tobler HG, Starnes VA, Ramasamy N, Oyer PE. Clinical experience with the Novacor ventricular assist system. J Thorac Cardiovasc Surg. 1991;102:578–587[Abstract]
  13. Rose EA, Levin HR, Frazier HO, Burton NA, Lefrak EA. Artificial circulatory support with textured inner surfaces. Circulation. 1994;90:II87–91
  14. Hetzer R, Hennig E, Schiessler A, Friedel N, Warnecke H, Adt M. Mechanical circulatory support and heart transplantation. J Heart Lung Transplant. 1992;11:175–181
  15. Blum A, Sclarovsky S, Rehavia E, Shohat B. Levels of T lymphocyte subpopulations, interleukin 1 beta, and soluble interleukin 2 receptor in acute myocardial infarction. Am Heart J. 1994;127:1226–1230[CrossRef][ISI][Medline]
  16. Katz SD, Rao R, Berman JW. Pathophysiological correlates of increased serum tumor necrosis factor in patientswith congestive heart failure. Relation to nitric oxide dependent vasodilation in the forearm circulation. Circulation. 1994;90:12–16[Abstract/Free Full Text]
  17. Wiedermann CJ, Beimpold H, Herold M, Knapp E, Braunsteiner H. Increased levels of serum neopterin and decreased production of neutrophil superoxide anions in chronic heart failure with elevated levels of tumor necrosis factor alpha. J Am Coll Cardiol. 1993;22:1897–1901[Abstract]
  18. Hasper D, Hummel M, Kleber FX, Reindl I, Volk HD. Systemic inflammation in patients with heart failure. Eur Heart J. 1998;19:761–765[Abstract/Free Full Text]
  19. Ferrari R, Bachetti T, Confortini R. Tumour necrosis factor soluble receptors in patients with various degrees of congestive heart failure. Circulation. 1995;92:1479–1486[Abstract/Free Full Text]
  20. Aukrust P, Ueland T, Muller F. Elevated circulating levels of C-C chemokines in patients with congestive heart failure. Circulation. 1998;97:1136–1143[Abstract/Free Full Text]
  21. Anker SD, Clark AL, Kemp M. Tumour necrosis factor and steroid metabolism in chronic heart failure: possible relation to muscle wasting. J Am Coll Cardiol. 1997;30:997–1001[Abstract]
  22. Niebauer J, Pflaum C-D, Clark AL. Deficient insulin-like growth factor-I in chronic heart failure predicts altered body composition, anabolic deficiency, cytokine and neurohormonal activation. J Am Coll Cardiol. 1998;32:393–397[Abstract/Free Full Text]
  23. Berry C, Clark AL. Catabolism in chronic heart failure. Eur Heart J. 2000;21:521–532[Free Full Text]
  24. Leyva F, Anker SD, Godsland IF. Uric acid in chronic heart failure: a marker of chronic inflammation. Eur Heart J. 1998;19:1814–1822[Abstract/Free Full Text]
  25. Loebe M, Hennig E, Müller J, Spiegelsberger S, Weng Y, Hetzer R. Long-term mechanical circulatory support as a bridge to transplantation, for recovery from cardiomyopathy, and for permanent replacement. Eur J Cardiothorac Surg. 1997;11:S18–24[Abstract/Free Full Text]
  26. Massad MG, McCarthy PM, Smedira NG. Does successful bridging with the implantable left ventricular device affect cardiac transplantation outcome? J Thorac Cardiovasc Surg. 1996;112:1275–1283[Abstract/Free Full Text]
  27. Kluft C, Dooijewaard G, Emeis JJ. Role of the contact system in fibrinolysis. Semin Thromb Hemost. 1987;13:50–68[ISI][Medline]
  28. Loebe M, Gorman K, Burger R, Gage JE, Harke C, Hetzer R. Complement activation in patients undergoing mechanical circulatory support. ASAIO J. 1998;44:M340–346[ISI][Medline]
  29. Torre-Amione G, Stetson SJ, Youker KA. Decreased expression of tumour necrosis factor-alpha in failing human myocardium after mechanical circulatory support: A potential mechanism for cardiac recovery. Circulation. 1999;100:1189–1193[Abstract/Free Full Text]
  30. Ankersmit HJ, Tugulea S, Spanier T. Activation-induced T-cell death and immune dysfunction after implantation of left-ventricular assist device. Lancet. 1999;354:550–555[CrossRef][ISI][Medline]
  31. Vanderheyden M, Kersschot E, Paulus WJ. Pro-inflammatory cytokines and endothelium-dependent vasodilation in the forearm. Serial assessment in patients with congestive heart failure. Eur Heart J. 1998;19:747–752[Abstract/Free Full Text]
  32. Hammerschmidt DE, Stroncek DF, Bowers TK. Complement activation and neutropenia during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1981;81:370–377[Abstract]
  33. Butler J, Chong GL, Baigrie RJ. Cytokine response to cardiopulmonary bypass with membrane and bubble oxygenator. Ann Thorac Surg. 1992;53:833–888[Abstract]
  34. Keel M, Schregenberger N, Steckholzer U. Endotoxin tolerance after severe injury and its regulatory mechanisms. J Trauma. 1996;41:430–437[ISI][Medline]
  35. Heinzelmann M, Miller M, Platz A, Gordon LE, Herzig DO, Polk HC. Heparin and enoxaparin enhance endotoxin-induced tumour necrosis factor-alpha production in human monocytes. Ann Surg. 1999;229:542–550[CrossRef][ISI][Medline]

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