Russian Heart Failure Journal 2011year Immunoinflammatory mechanisms of heart remodeling in patients with chronic obstructive pulmonary disease


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2011/

Immunoinflammatory mechanisms of heart remodeling in patients with chronic obstructive pulmonary disease

Nekrasov A. A.
State Budgetary Educational Institution of Higher Professional Education, “Nizhny Novgorod State Medical Academy” of the RF Ministry of Healthcare, Pl. Minina and Pozharskogo 10/1, Nizhny Novgorod 603005

Keywords: immune inflammation, remodeling, chronic obstructive pulmonary disease

DOI: 10.18087/rhfj.2011.1.1466

Background. Influence of immunoinflammatory and neurohormonal changes in development of pulmonary hypertension (PH) and heart remodeling in patients with chronic obstructive pulmonary disease (COPD) remains unknown. Objective. To assess the contribution of immunoinflammatory mechanisms in heart remodeling, according to 2‑years observation of patients with COPD, depending on the level of LH. Materials and methods. 53 patients with COPD were observed during 2 years. The mean pulmonary artery pressure (MPAP), the state of right and left ventricles and atriums (RV, LV, RA, LA) according to echocardiography, determination of NT‑proBNP level, tumor necrosis factor-α (TNF-α), interleukin-6 (I-6), aldosterone and rennin were examined. Two groups of patients were identified: 1 – without PH (n=28) and 2 – with PH (n=25). Dynamics of echocardiography and its relationship with markers of systemic inflammation and RAAS were evaluated in each group. Results. Numerous correlations between baseline cytokine levels and negative dynamics of echocardiography were revealed. The level of IL-6 is directly connected with increased systolic LV size (r=0.36; p=0.044), RA (r=0.49; p=0.020) and RV (r=0.56; p=0.023). MPAP correlated with increasing of LV posterior wall thickness, RV systolic size and RA (p<0.05). The dynamics in group 1 showed the increase of RV, LV, RA, LA and MPAP (p<0.05), and the degree of increase directly correlated with cytokines, rennin level, but not with levels. In group 2, significant increase in LV and LA size was revealed, which correlated with PH level and with cytokine level. Thus, among possible mechanisms that trigger the remodeling of left and right heart chambers, is the activation of immunoinflammatory system. Its effect on myocardium has independent significance and is only partially mediated by PH exacerbation. In early stages of disease (before PH development) immunoinflammatory changes have predominant value as well as for myocardial remodeling and PH fixing. In later stages the role of PH in remodeling process increases.
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Nekrasov A. A. Immunoinflammatory mechanisms of heart remodeling in patients with chronic obstructive pulmonary disease. Russian Heart Failure Journal. 2011;12(1):42-46.

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