Key result
Combining cardiac resynchronisation therapy with other interventions in patients with ischemic cardiomyopathy decreased systemic inflammation (IL-6, TNF-alpha, CRP) compared to pure CRT.
Why the study?
Does combining CRT with coronary stenting and AV node ablation improve systemic inflammation and neurohumoral status in patients with ischemic cardiomyopathy compared to CRT alone?
Observational (n=59)
Does combining CRT with coronary stenting and AV node ablation improve systemic inflammation and neurohumoral status in patients with ischemic cardiomyopathy compared to CRT alone?
Combining CRT with other interventions such as coronary stenting and AV node ablation is associated with a significant decrease in systemic inflammation compared to CRT alone in patients with ischemic cardiomyopathy.
Does not warrant practice change in ischemic cardiomyopathy; supports hypothesis that adjunctive interventions with CRT reduce inflammation.
The purpose of this research was to study the influence of cardiac resynchronisation therapy (CRT) in combination with other interventional techniques used during one hospital stay on systemic inflammation and neurohumoral status in patients with ischemic cardiomyopathy (ICMP). The best response to CRT was estimated in 59 patients with ICMP (mean age 588.3 years, 92% males).The patients were divided into 2 groups: Group I patients (n=48) included those with 'pure' CRT, while Group II patients (n=11) underwent CRT, coronary stenting (CS), radiofrequency atrioventricular node ablation (RFA). All interventions were performed during one hospital stay. There were no significant differences in demographic characteristics between the groups. Mean follow-up was 6.0 [2.0; 16.0] months. Plasma levels of Nt-proBNP, interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-alpha (TNF-), C-reactive protein (CRP), urinary levels of epinephrine and norepinephrine (NE) were measured. The patients with a decrease in left ventricular end-systolic volume 15% were classified as responders. There were no significant differences in responders between the groups and was equal to 32 (67%) and 9 (82%) respectively. At baseline the plasma levels of IL-6 and CRP were higher in Group II as compared with Group I: 9.3 [4.6; 14.8] vs 3.3 [1.9; 5.2] pg/ml, respectively (p=0.004) and 8.0 [6.0; 10.2] vs 3.2 [1.5; 5.1] mg/ml respectively (p=0.065). At baseline the urinary NE level was lower in Group II as compared with Group I: 30.0 [17.6; 34.4] vs 58.0 [38.5; 74.6] nmol/ml respectively (p=0.023). During follow-up in Group I only Nt-proBNP level (p=0.015) tended to decrease. In Group II the levels of IL-6 (p=0.038), TNF- (p=0.024), CRP (p=0.031) decreased and NE level increased (p=0.038). Thus, the combination of CRT with other interventions is associated with a decrease in systemic inflammation and an impact on the neurohumoral status of patients with ICMP as compared with 'pure' CRT.
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Va et al. (2015) conducted an observational in Ischemic cardiomyopathy (n=59). Cardiac resynchronisation therapy combined with coronary stenting and/or radiofrequency atrioventricular node ablation vs. 'Pure' cardiac resynchronisation therapy was evaluated on Response to CRT (decrease in left ventricular end-systolic volume ≥15%). Combining cardiac resynchronisation therapy with other interventions in patients with ischemic cardiomyopathy decreased systemic inflammation (IL-6, TNF-alpha, CRP) compared to pure CRT.
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