Increased low-grade inflammation is associated with lack of functional response to carvedilol in patients with systolic heart failure

Gabriele Fragasso, Roberto Spoladore, Francesco Maranta, Angelo Corti, Guido Lattuada, Barbara Colombo, Massimo Locatelli, Anna Salerno, Giliola Calori, Luis Briceno, Anna B. Alfieri, Gianluca Perseghin, Alberto Margonato

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The aim of this study was to evaluate, according to functional response, the neuroendocrine and inflammatory status in patients with chronic heart failure before and after therapy with carvedilol. METHODS AND RESULTS: Serum tumor necrosis factor-α (TNF-α) soluble receptors (sTNF-R1 and sTNF-R2), interleukin (IL)-10 and IL-18, chromogranin A (CgA) and brain natriuretic peptide (pro-BNP) were measured in 37 New York Heart Association class II to IV heart failure patients, at baseline and after 6 months of therapy with carvedilol. Patients were divided in two groups according to whether, following carvedilol, left-ventricular ejection fraction (LVEF) had increased by at least 5% (17 patients) or not (20 patients). Baseline LVEF was higher in nonresponders (38 ± 5 vs. 31 ± 7%, P = 0.002). In responders, LVEF increased from 31 ± 7 to 51 ± 7% (P <0.0001), whereas in nonresponders it decreased from 38 ± 5 to 33 ± 7%, (P = 0.02). sTNF-R1 (P = 0.019) and sTNF-R2 (P = 0.025) increased in nonresponders, whereas they did not change in responders. After carvedilol, IL-10 was significantly higher in responders (P = 0.03). Conversely, no significant IL-18 and CgA changes were observed in either group. CgA was not significantly different between groups at baseline and after carvedilol in either group, whereas pro-BNP significantly increased in nonresponders (from 438 ± 582 to 1324 ± 1664 pg/ml, P = 0.04) and decreased in responders (from 848 ± 1221 to 420 ± 530 pg/ml, P = 0.08). CONCLUSION: Increased inflammatory activation observed only in heart failure patients not improving left-ventricular function after carvedilol may indicate that inflammation, either as a direct cause or as a consequence, is associated with progressive ventricular dysfunction.

Original languageEnglish
Pages (from-to)49-56
Number of pages8
JournalJournal of Cardiovascular Medicine
Volume14
Issue number1
DOIs
Publication statusPublished - Jan 2013

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Keywords

  • carvedilol
  • heart failure
  • inflammation
  • natriuretic peptides
  • neuroendocrine
  • receptors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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