Evaluation of proinflammatory cytokines and brain natriuretic peptide in patients with rheumatic heart diseases and coronary heart disease complicated by chronic heart insufficiency

Objective. To study proinflammatory cytokines and brain natriuretic peptide (BNP) in patients with rheumatic heart diseases (RHD) and coronary heart disease (CHD) complicated by chronic heart insufficiency (CHI). Material and methods. 54 pts with CHI (among them 16 with RHD and 38 with CHD with signs of CHI ofll-IV functional class according to NYHA that correspond to 11A-III stage according to N.D. Strazesko-V.H. \frsilenko classification) and 30 healthy persons of control group were examined. Besides clinical evaluation common laboratory and instrumental methods were used. Thorough echocardiography analysis, quantitative evaluation of serum TNF a, IL6 and BNP by immuno-enzyme assay was performed. Results. Direct correlation between cytokines and BNP levels and pts with CHI clinical state severity was revealed. These indiccs significantly differed in coronary and non-coronary (RHD) CHI. TNF a concentration was minimal in mitral stenosis. Maximal concentrations of IL6 and TNF a were revealed in tricuspid regurgitation. TNF a concentration elevated with increase of heart linear dimensions. BNP showed similar but less prominent tendencies. Conclusion. Significant difference of studied indices in coronary and non-coronary (RHD) CHI was shown. Despite of similarity of CHI clinical features levels of inflammation biological indices in RHD was significantly lower than in CHD that requires further discussion.

rheumatic heart diseases, chronic heart insufficiency, tumor necrosis factor a, interleukin 6, brain natriuretic peptide

1. <div><p>Bozkurt В., Kribbs S.B., Clubb FJ. et al. Pathophysiologically relevant concentrations of tumor necrosis factor-alfa promote progressive left ventricular dysfunction and remodeling in rats. II. Circulation, 1998,97, 1382-1391</p><p>Dutka D.P., Elbern J.S., Delamere F. Tumor necrosis factor alpha in severe congestive heart failure. Br. Heat. J., 1993, 70, 12. 141-143</p><p>Katz S.D., Rao R., Berman J.W. et al. Pathophysiologicaly correlates of increased serum tumor necrosis factor in patients with 13. congestive heart failure: relation to nitryc oxide-dependent vasodilatation in the forearm circulation. Circulation, 1994, 90, 14. 12-16</p><p>Levine B., Kalman J., Mayer L. et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N. Engl. 15. J. Med., 1990, 323, 236-241</p><p>Mann. D.J., Young J.B. Basic mechanisms in congestive heart failure. Recognizing the role of proinflammatory cytokines. Chest, 1994, 105, 897-904 16.</p><p>Matsumori A., Yamada Т., Suzuki H. et al. Increased circulating cytokines in patients with myocarditis and cardiomyopathy. Br. Heart J., 1994,72,561-566 O.Yegin, M.Coskun, H.Ertug. Cytokines in acute rheumatic fever. J. Autoimmun., 2001, 16(3), 363-367</p><p>Kutukculer N., Narin N. Plasma interleukin-7 (IL-7) and IL-8 concentrations in acute rheumatic fever and chronic rheumatic heart disease. Clin. Exp. Immunol., 1993, 91(3), 429-436</p><p>Narin N. Kutukculer N., Ozyurek R., Bakilcr A.R. 18. Lymphocyte subsets and plasma IL-t alpha, IL-2, and TNF- alpha concentrations in acute rheumatic fever and chronic rheumatic heart disease. Scand. J. Rheumatol., 1995, 24(6), 383-385</p><p>Morris K., Mohan C., W&amp;hi P.L., et al. Enhancement of IL-1, IL-2 production and IL-2 receptor generation in patients with acute rheumatic fever and active rheumatic heart disease: a prospective study. Arch. Dis. Child., 1992,67(11), 1373-1375</p><p>Zedan M.M., el-Shennawy F.A., Abou-Bakr H.M.,.al-Basousy A.M. Interleukin-2 in relation to T cell subpopulations in rheumatic heart disease. J. Rheumatol. ,1989, 16(11), 1436-1442</p><p>Насонов Е.Л., Самсонов М.Ю., Беленков Ю.Н., Фукс Д. Иммунопатология застойной сердечной недостаточности: роль цитокинов. Кардиол., 1999, 39,3, 66-73</p><p>Reid М.В., Li Y.P. Cytokines and oxidative signaling in skeletal muscle. Acta Physiol. Scand., 2001,171, 225-232 Kiemer A.K., follmar A.M. The atrial natriuretic peptide regulates the production of inflammatory mediators in macrophages. Ann. Rheum. Dis., 2001, 60, 68-70.</p><p>Deswal A., Petersen N.J., Feldman A.M. et al. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone Trial (VEST). Circulation, 2001, 103, 2055-2059</p><p>Parissis J.T., Adamopoulos S., fenetsanou K.F. et al. Clinical and neurohormonal correlates of circulating granulocyte- macrophage A9-10 colony-stimulating factor in severe heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am. J. Cardiol., 2000, 86, 707-710.</p><p>Oral H., Sivasubramanian N. Dyke D.B. et al. Myocardial proinflammatory cytokine expression and left ventricular remodeling in patients with chronic mitral regurgitation. Eur. J. Heart Fail., 2000, 2(4), 387-91</p><p>Ikeda U., Yamamoto K., Akazawa H. et al. Plasma cytokine levels in cardiac chambers of patients with mitral stenosis with congestive heart failure. Cardiol., 1996,87 (6),476-480</p></div><br />