Inflammatory markers of CHF not reduced after LVAD implantation

מתוך medicontext.co.il
LONDON (Reuters Health) – Use of a left ventricular assist device (LVAD) does not ameliorate the chronic inflammatory state associated with heart failure. There is only a short-term reduction in tumour necrosis factor (TNF) alpha, and interleukin-6 (IL-6), and no change in CD14 or tumour necrosis factor receptor levels, European researchers report.

Dr. A. L. Clark, from Castle Hill Hospital, Hull, UK, and colleagues studied 48 patients, mean 45.3 years of age, who had New York Heart Association class IV heart failure. These patients underwent left ventricular assist device implantation as a bridge to heart transplantation.

At 1 week after the left ventricular assist device was implanted, levels of TNF-alpha fell (p = 0.008), but by 90 days they had returned to preoperative levels. IL-6, activated complement, and elastase also dropped progressively for up to 40 days but were rising by 90 days after implantation, Dr. Clark's team notes.

CD14 gradually rose by 90 days after left ventricular assist device implantation (p = 0.006), and there was no change in tumour necrosis factor receptor, according to the report in the December 2001 issue of the European Heart Journal.

Among these patients the 1-year survival rate was 35%. The only predictor of survival was body mass index. Of the 16 patients whose body mass index was greater than 25, the 1-year survival rate was 63% compared with 22% of the 32 patients whose body mass index was less than 25 (p = 0.003), the researchers found.

They comment that the left ventricular assist device "did not seem to function as a specific anticachexia intervention, as suggested by the fact that there was a further (small) decline in body mass index by the 90 day follow-up."

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