No abstract

No abstract

rogressive deterioration of ventricular function is frequently observed in patients with chronic heart failure (CHF) and recent reports, including ours, have shown that elevated concentrations of cardiac troponin T and heart-type fatty acid-binding protein (H-FABP), a low molecular protein that is abundant in the cytosol of cardiomyocytes, identify patients with ongoing myocardial damage (OMD) who are at increased risk for future cardiac events. [1][2][3] The process of OMD is still unclear, but is possibly related to necrosis and/or apoptosis of cardiomyocytes. [4][5][6] Several studies have demonstrated that activated tumor necrosis factor (TNF) and the Fas/Fas ligand (FasL) system play a significant role in the apoptosis of cardiomyocytes. [7][8][9] The Fas molecule (Fas) is a transmembrane protein and a member of the TNF receptor family, 10 which can initiate apoptosis. The soluble form of Fas (sFas) is produced by alternative splicing of the transcript 11 and is present in circulating blood. 12 Increased serum concentrations of sFas are considered to reflect activation of the Fas/FasL system 13 in vivo. TNF-is a proinflammatory cytokine with a crucial role in cell death, including apoptosis of cardiomyocytes. 8,9 Furthermore, the serum concentrations of sFas, 14 TNF-, 15 reported as a sensitive cytosolic marker of OMD, are increased in accordance with the severity of CHF. However, there are few studies investigating the relationships between OMD and TNF and the Fas/FasL system in patients with CHF, so the aim of the present study was to discover their pathophysiological linkage in patients with CHF. Methods PatientsWe studied 38 consecutive patients with CHF (23 men, 15 women, age 66±12 years). The severity of CHF was New York Heart Association (NYHA) functional class II in 23, NYHA III in 13 and IV in 2 patients. The etiology of CHF was previous myocardial infarction in 12, hypertensive heart disease in 11, dilated cardiomyopathy in 9, valvular heart disease in 3, congenital heart disease in 2 patients, and hypertrophic cardiomyopathy in 1 patient. Exclusion criteria were recent (within 3 months) history of ischemic heart disease and myocarditis, active pulmonary and liver disease, autoimmune disorder, infection, malignant disease, muscle disorder (creatine kinase (CK) ≥200 IU/L) and renal insufficiency (serum creatinine ≥2.5 mg/dl). Informed consent was obtained from all patients. Measurements of Biochemical MarkersBlood samples were obtained in the morning from the CHF patients while they were in a stable condition after an overnight fast. Samples were promptly centrifuged, and the plasma and sera were stored below -30°C. sFas (Medical & Biological Laboratories Co, Ltd, Nagoya, Japan; detection limit: 0.5 ng/ml), TNF-(Japan Immunoreseach

SummaryOngoing myocardial damage detected as elevated serum cardiac troponin T (cTnT) indicates increased risk for future cardiac events in patients with chronic heart failure. Whether elevated cTnT is associated with adverse outcomes in patients with hypertension (HT) without left ventricular (LV) systolic dysfunction is unknown.We measured cTnT levels in 176 patients with essential HT without LV systolic dysfunction (LV ejection fraction ≤ 55%), renal failure, and prior cardiovascular or cerebrovascular diseases and 39 normal controls. Levels of cTnT were elevated ( ≥ 0.02 ng/mL) in 15 (9%) of the 176 patients and in 0 (0%) of the 39 normal controls (P = 0.04). The rate of diabetes mellitus (DM), the cardiothoracic ratio, plasma B-type natriuretic peptide (BNP) value, and LV mass index were significantly higher in patients with than without elevated cTnT (DM, 8/15 versus 29/161, P = 0.004; cardiothoracic ratio, 54.5 ± 4.5 versus 51.6 ± 5.2%, P = 0.04; BNP, 103.3 ± 142.3 versus 36.9 ± 50.7 pg/mL, P = 0.04; LV mass index, 227 ± 87 versus 152 ± 57 g/m 2 , P = 0.0001). Kaplan-Meier analysis demonstrated that significantly fewer (P < 0.000001) patients with, than without elevated cTnT remained free of events (hospitalization due to cardiovascular or cerebrovascular disease, n = 34). Stepwise Cox multivariate analysis revealed that elevated cTnT (hazard ratio, 6.58; P = 0.000001) and smoking (hazard ratio, 2.24; P = 0.04) were independent predictors of events.The present findings indicate that cTnT is a novel and useful predictor of future cardiovascular or cerebrovascular events in hypertensive patients. (Int Heart J 2011; 52: 164-169)

No abstract