Document Detail


Atrial fibrillation is associated with increased neurohumoral activation and reduced exercise tolerance in patients with non-ischemic dilated cardiomyopathy.
MedLine Citation:
PMID:  17027102     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess atrial fibrillation (AF) associated differences in proinflammatory cytokines, natriuretic peptide levels and exercise capacity in patients with heart failure (HF) secondary to non-ischemic dilated cardiomyopathy (NIDC). METHODS: We studied 147 NIDC patients, mean age 58.3+/-12.5 years, left ventricular (LV) ejection fraction 27.8+/-10.9% and NYHA class II-III. Neurohumoral activation was assessed by measurement of interleukin IL-1, IL-6, tumor necrosis factor-a (TNF-a), its soluble receptors sTNFR I and II, N-terminal atrial (NT-ANP) and -brain (NT-BNP) natriuretic peptide levels, and functional class was assessed by cardiopulmonary exercise test. RESULTS: Forty patients (27.5%) had chronic AF and they did not differ in age, LV ejection fraction or HF duration compared to patients in sinus rhythm (SR). AF was associated with increased levels of IL-6 (p=0.001), TNF-a (p=0.002), sTNFRI (p=0.023), NT-ANP (p<0.001) and NT-BNP (p=0.003), decreased exercise duration (p<0.001) and slightly reduced maximal oxygen consumption at peak exercise (p=0.07) compared to SR patients. No significant differences in cytokine and natriuretic peptide levels or exercise tolerance were noted when patients in AF were compared to the subgroup of SR with restrictive LV filling pattern. Multivariate analysis showed that NT-ANP (p=0.003) and IL-6 (p=0.006) plasma levels were independently associated with the presence of AF in our patient population. CONCLUSION: AF is associated with increased inflammatory state, natriuretic peptide levels and reduced exercise capacity in patients with HF secondary to NIDC. These findings suggest that the presence of AF in HF represents a more advanced stage of the syndrome.
Authors:
Frangiskos I Parthenakis; Alexandros P Patrianakos; Emmanuel I Skalidis; George F Diakakis; Evangelos A Zacharis; Gregory Chlouverakis; Ioannis K Karalis; Panos E Vardas
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2006-10-04
Journal Detail:
Title:  International journal of cardiology     Volume:  118     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-23     Completed Date:  2007-08-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  206-14     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Heraklion University Hospital, Crete, Greece. fparth@med.uoc.gr
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / blood*,  etiology*
Cardiomyopathy, Dilated / complications*,  ultrasonography
Chronic Disease
Cytokines / blood
Exercise Test
Exercise Tolerance*
Female
Heart Failure / etiology*,  physiopathology*
Heart Rate
Humans
Male
Middle Aged
Natriuretic Peptides / blood
Neurotransmitter Agents / blood*
Oxygen Consumption
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Cytokines; 0/Natriuretic Peptides; 0/Neurotransmitter Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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