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Expresión de citoquinas proinflamatorias miocárdicas y remodelación ventricular izquierda en pacientes con

Hakan Oral¹, Natarajan Sivasubramanian, David B Dyke

¹Division of Cardiology, University of Michigan and Veterans Affairs Medical Centers, Ann Arbor, USA. oralh@umich.edu

|February 20, 2003

Resumen

La regurgitación mitral crónica (MR) aumenta el factor de necrosis de tumores del miocardio alfa (TNF-alfa) en los pacientes. La cirugía de reparación de la válvula mitral reduce el TNF-alfa y mejora la remodelación ventricular izquierda, lo que indica el papel del TNF-alfa en la MR.

Área de la Ciencia:

Biología Cardiovascular Biología Cardiovascular
La medicina molecular es una medicina molecular.
Cirugía cardíaca Cirugía cardíaca.

Sus antecedentes:

El estiramiento induce el factor de necrosis tumoral del miocardio alfa (TNF-alfa) en modelos animales.
La regurgitación mitral crónica (MR) causa sobrecarga de volumen en el ventrículo izquierdo (LV).
El estudio investiga la inducción de TNF-alfa por sobrecarga de volumen de LV en pacientes con MR.

Objetivo del estudio:

Determinar si la sobrecarga de volumen de LV en pacientes con RM induce la expresión miocárdica y sistémica de TNF-alfa.
Evaluar la relación entre la expresión de TNF-alfa y la remodelación de LV.
Evaluar el efecto de la reparación de la válvula mitral (MV) en los niveles de TNF-alfa y la remodelación de la válvula mitral.

Principales métodos:

TNF-alfa y receptores plasmáticos medidos en 26 pacientes con RM antes de la reparación de MV y 9 después de la reparación de MV.
ARNm TNF-alfa miocárdico cuantificado en 11 pacientes con RM y 10 corazones de donantes a través de RT-PCR.
Expresión correlacionada de TNF-alfa miocárdico con volúmenes de LV y parámetros de remodelación.

Principales resultados:

Los pacientes con RM exhibieron elevados niveles plasmáticos de TNF-alfa y receptores en comparación con los controles.
El ARNm TNF-alfa miocárdico fue significativamente mayor en pacientes con RM que en corazones de donantes.
La reparación de MV disminuyó los niveles plasmáticos de TNF-alfa y los receptores.
El TNF-alfa miocárdico se correlacionó con los volúmenes de LV e inversamente con la remodelación de LV después de la cirugía.

Conclusiones:

El TNF-alfa se expresa en el miocardio y el plasma de los pacientes con MR.
La cirugía de la válvula mitral invierte la expresión de TNF-alfa y alivia la sobrecarga de volumen de LV.
La expresión de TNF-alfa está vinculada a la remodelación de LV en MR, lo que sugiere un papel en su patogénesis.

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