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T-lymphocyte subsets as noninvasive markers of cardiomyopathy
T Kanda1, T Yokoyama, S Ohshima
1Gumma University, Prefectural Maebashi Hospital, Japan.
Insights
An elevated CD4+2H4+/CD8+CD11- ratio in peripheral blood lymphocytes can help differentiate dilated cardiomyopathy (DCM) from myocarditis and coronary heart disease. This noninvasive marker shows promise for diagnosing DCM in heart failure patients.
Area of Science:
- Immunology
- Cardiology
Background:
- Congestive heart failure (CHF) diagnosis can be challenging, requiring invasive procedures.
- T-lymphocyte subsets in peripheral blood may offer noninvasive diagnostic markers for heart conditions.
Purpose of the Study:
- To investigate T-lymphocyte subset profiles in patients with symptomatic CHF.
- To determine if specific T-lymphocyte ratios can aid in the differential diagnosis of dilated cardiomyopathy (DCM), myocarditis (MC), and coronary heart disease (CHD).
Main Methods:
- Two-color laser flow cytometry was used to analyze peripheral blood T-lymphocyte subsets in 58 CHF patients and 16 healthy controls.
- Patients were diagnosed with DCM (n=24), MC (n=12), or CHD (n=16) via catheterization and endomyocardial biopsy.
Main Results:
- The CD8+CD11- (cytotoxic T) subset was significantly lower in DCM patients compared to MC and CHD patients.
- The CD4+2H4+ (suppressor/inducer T) subset was significantly higher in DCM patients compared to MC and CHD patients.
- A CD4+2H4+/CD8+CD11- ratio > 1.6 demonstrated 79% sensitivity and 70% specificity for diagnosing DCM, with a significantly higher ratio observed in DCM patients (2.2 +/- 0.9) versus controls, MC, and CHD.
Conclusions:
- An elevated CD4+2H4+/CD8+CD11- ratio in peripheral blood lymphocytes is a potential noninvasive marker for differentiating DCM from MC and CHD.
- This ratio may improve the diagnostic accuracy for dilated cardiomyopathy in patients with heart failure.
Abstract:
Fifty-eight patients with symptomatic congestive heart failure were examined for T-lymphocyte subsets in the peripheral blood using two-color laser flow cytometry as a noninvasive diagnostic procedure. The final diagnosis established by catheterization and endomyocardial biopsy were dilated cardiomyopathy (DCM, n = 24), myocarditis (MC) by the Dallas criteria (n = 12), and coronary heart disease (CHD, n = 16). The CD8+CD11- (cytotoxic T) subset was significantly low in patients with DCM (13.9 +/- 4.4 vs. controls, p less than 0.05) in comparison with MC (20.7 +/- 10.9) and CHD (22.3 +/- 5.9). Moreover, the CD4+2H4+ (suppressor/inducer T) subsets were higher in patients with DCM (27.3 +/- 6.9 vs. controls, p less than 0.01) than in those with MC (17.3 +/- 7.8) and CHD (15.6 +/- 7.9). The CD4/CD8 and CD4+2H4+/CD8+CD11- ratio were examined and compared with those of normal controls (NC n = 16). The CD4+2H4+/CD8+CD11- ratio was clearly higher in patients with DCM (2.2 +/- 0.9 vs. controls, p less than 0001) than in those with MC (1.1 +/- 0.6) CHD (0.9 +/- 0.7). A CD4+2H4+/CD8+CD11- ratio of greater than 1.6 was considered to facilitate diagnosis of dilated cardiomyopathy with 79% sensitivity and 70% specificity. There was no significant increase in the ratios between MC and CHD. However, the proportion of the CD8+Leu7+ (natural suppressor) subset of circulating T lymphocytes in patients with MC was statistically higher (19.1 +/- 6.3% vs. controls, p less than 0.05) than in DCM or CHD. An elevated ratio of CD4+2H4+/CD8+CD11- among peripheral blood lymphocytes may thus be a useful marker for differential diagnosis of dilated chronic cardiomyopathy from myocarditis and coronary heart disease.