Evaluating the effects of cardiac resynchronization therapy on pathophysiological pathways of heart failure using
Hamza Sunman1, Adem Özkan, Hikmet Yorgun
1Ministry of Health Dışkapı Yıldırım Beyazıt Research and Educational Hospital. hamzasunman@gmail.com.
Insights
Cardiac resynchronization therapy (CRT) improved heart failure (HF) by reducing biomarkers for myocyte stress, extracellular matrix remodeling, and oxidative stress. This study assessed long-term CRT effects on HF pathophysiological pathways using surrogate biomarkers.
Area of Science:
- Cardiology
- Biomarker Research
- Heart Failure Pathophysiology
Background:
- Cardiac resynchronization therapy (CRT) is used for heart failure (HF), but its effects on underlying pathophysiological pathways are not fully understood.
- Previous studies have not comprehensively evaluated multiple HF pathways simultaneously after CRT.
- This research investigates the long-term impact of CRT on six key pathophysiological pathways in HF patients.
Purpose of the Study:
- To assess the long-term effects of CRT on six distinct pathophysiological pathways in heart failure patients.
- To utilize surrogate biomarkers to quantify changes in these pathways following CRT implantation.
- To identify specific pathophysiological mechanisms influenced by CRT in HF management.
Main Methods:
- A cohort of 44 heart failure patients received CRT.
- Six groups of biomarkers (inflammation, oxidative stress, ECM remodeling, neurohormonal, myocyte injury, myocyte stress) were measured at baseline and 1 year post-CRT.
- CRT responders were defined by a ≥15% reduction in left ventricular end-systolic volume at 12 months.
Main Results:
- 72.7% of patients were CRT responders at 1-year follow-up.
- Responders showed significant reductions in biomarkers for myocyte stress, extracellular matrix (ECM) remodeling, and oxidative stress.
- Specific biomarkers like IL-6, MPO, oxLDL, MMP-2, galectin-3, troponin T, and BNP decreased significantly in responders.
Conclusions:
- CRT significantly impacts specific pathophysiological pathways in heart failure patients.
- The study confirmed reductions in biomarkers related to myocyte stress, ECM remodeling, and oxidative stress among CRT responders.
- These findings highlight the beneficial effects of CRT on key HF mechanisms, measurable through surrogate biomarkers.
Background:
Several studies have investigated the effects of cardiac resynchronization therapy (CRT) on heart failure (HF), but none have evaluated the pathophysiological pathways involved in a single group of patients. Therefore, this study aims to assess the long-term effects of CRT on six different patho-physiological pathways involved in the process of HF by the use of surrogate biomarkers.
Methods:
In a group 44 patients with HF, six groups of biomarkers were measured, both at baseline and 1 year after CRT implantation: inflammation (interleukin [IL]-4, IL-6, tumor necrosis fac-tor [TNF]-a, high sensitive C-reactive protein [hsCRP]); oxidative stress (myeloperoxidase [MPO], oxidized low-density lipoprotein [oxLDL], uric acid); extracellular matrix (ECM) remodeling (matrix metalloproteinase [MMP]-2 and -9, galectin-3, procollagen III N-terminal propeptide [prokol-3NT]); neurohormonal pathways (endothelin-1, chromogranin-A); myocyte injury (troponin T, creatine kinase MB fraction [CK-MB]), myocyte stress (B-type natriuretic peptide [BNP]). CRT responders were de-fined as patients with ≥ 15% reduction in left ventricular end-systolic volume at 12 months post-CRT.
Results:
At 1-year follow-up, 72.7% (n = 32) of the patients were categorized as CRT responders. In these patients, the levels of IL-6, MPO, oxLDL, MMP-2, galectin-3, troponin T, and BNP were significantly reduced as compared to baseline values. While the biomarkers for myocyte stress (effect size = 0.357; p = 0.001), ECM remodeling (effect size = 0.343; p = 0.015) and oxidative stress (effect size = 0.247; p = 0.039) showed a significant change in the CRT responders during follow-up, the biomarkers for other pathophysiological pathways did not show a significant alteration.
Conclusions:
In the present study, a significant reduction was only observed in the biomarkers of myo-cardial stress, ECM remodeling, and oxidative stress among all the CRT responder subjects. (Cardiol J 2018; 25, 1: 42-51).
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