Relationship Between Ventricular Arrhythmias And Serum Levels Of Tumour Necrosis Factor Alpha And High Sensitivity C-reactive Protein

Objective:To evaluate the relationship between ventricular arrhythmias and serum levels of tumour necrosis factor alpha and high sensitivity C-reactive protein.Methods:The study consisted of 107 subjects.61 subjects with electrocardiographic evidence of ventricular arrhythmias(＞6 ventricular premature beats per minute).46 subjects without evidence of ventricular arrhythmias as control.Those subjects were divided into 4 groups.Group A consisted of 32 patients who had structural heart diseases and evidence of ventricular arrhythmias.Their mean age was 65.41±9.14 years,17 were men,21 had ventricular premature contractions and 11 had nonsustained ventricular tachycardia.24 had essential hypertension and 15 had coronary artery disease.Group B consisted of 22 patients who had structural heart disease but without ventricular arrhythmias.Their mean age was 60.95±8.76 years,11 were men,17 had essential hypertension and 9 had coronary artery disease.Group C consisted of 29 patients who had no structural heart diseases and with ventricular arrhythmias.Their mean age was 50.66±9.05 years,17 were men.21 had ventricular premature contractions and 8 had nonsustained ventricular tachycardia.Group D consisted of 24 healthy subjects without ventricular arrhythmias.Their mean age was 49.50±8.12 years,12 were men.All subjects underwent 24-hour ambulatory electrocardiographic monitoring,two-dimensional echocardiography and serum sampling for TNF-αand HsCRP measurement.TNF-αand HsCRP levels were determined using commercially available radioimmunoassay and immunoassay. Electrocardiographic parameters included left ventricular end-diastolic dimension (LVDd),interventricular septal end-diastolic thinkness(IVSTd),left ventricular posterior wall end-diastolic thinkness(LVPWTd),left ventricular ejection fraction (LVEF)and left ventricular fractional shortening(LVFS). Results:Compared with group B,group A bad higher levels of TNF-α(21.20±2.16 vs.19.69±2.11fmol/mL,p＜0.05)and HsCRP(3.31±2.12 vs.1.39±0.75 mg/L,p＜0.001),and also had larger LVDd(53.09±10.68 vs.45.80±5.27 mm,p＜0.05)and IVSTd(11.59±1.90 vs.10.59±1.43 mm,p＜0.05).Compared with group D,group C had higher levels of TNF-α(20.67±2.44 vs.19.24±1.54fmol/mL,p＜0.05)and HsCRP (2.99±1.81 vs.1.39±0.70 mg/L,p＜0.001),and also had larger LVDd{45.66±3.11 vs. 43.71±3.24 mm,p＜0.05).In group A,levels of HsCRP correlated positively with IVSTd(r=0.372,p＜0.05).In a multiple logistic regression analysis,levels of TNF-α(OR 1.373,95%CI 1.071～1.761,p＜0.05)and HsCRP(OR 2.737,95%CI 1.647～4.546,p＜0.001)and LVDd(OR 1.184,95%CI 1.057～1.327,p＜0.05)were risk factors of ventricular arrhythmias.Conclusions:In patients with ventricular arrhythmias,serum levels of TNF-αand HsCRP were significantly higher than those in control groups.It demonstrate that inflammation is involved in pathophysiology of ventricular arrhythmias and may be one of the mechanisms of ventricular arrhythmias.In patients who had structural heart diseases,LVDd and IVSTd were larger in those with ventricular arrhythmias and in whom levels of HsCRP correlated positively with IVSTd.In those patients ventricular remodeling was more serious and correlated to inflammation.LVDd was larger in those with ventricular arrhythmias but without structural heart diseases than those healthy subjects.It suggest that some patients with ventricular arrhythmias and a structurally normal heart may have subclinical cardiomyopathy.Levels of TNF-αand HsCRP and LVDd were important risk factors of ventricular arrhythmias.