| Objective Congestive Heart Failure ( CHF ) is the late stage of all the heart diseases, it has high incidence and mortality . There are two theories on the pathology and etiology of CHF: ventricular reconstruction and stimulation of neuro endocrine factors. Cytokines play critical roles in venticular reconstruction. Intercellural adhesion molecule-1(ICAM-1) is the key factor in inflammation of myocardium and in induction and interaction of necrocytosis of myocardial cells. The objective of our study is to measure the level of serum soluble ICAM-1 (sICAM-1) in patients with CHF .analyse the relationship between sICAM-1 and Angiotensin II (Angll)., C-reactive protein (CRP) .observe the change of serum sICAM-1 before and after Angiotensin II receptor blocker (ARB) Valsartan treatment. We hope that the relationship between serum sICAM-1 and heart failure ,the role of sICAM-1 in heart failure, and the mechanics and significence of ARB Valsartan in treatment of CHF can be obtained. Methods Sixty patients with CHF have been choosed according to NYHA criteria of cardiac function,they were divided randomly into two groups. Half of the patients were treated with conventional method with digoxin, diuretics and nitric acid ester, the other half with ARB 80mg/day in addition to conventional treatment. All of the patients were measured of the serum levels of ICAM-1, CRP, Angll in the morning without breakfast on the 2nd day of enrollment to the hospital. After the 3-4 weeks of treatment, the sICAM-1 level has been measured again in the same condition. Twenty healthy people have been choosed as healthy control group,sICAM-1 has been measured. Results1. The concentrations of serum sICAM-1, CRP and Angll in CHF patients are (736. 58 ± 189. 80) ug/K (14. 82 ± 11. 11) mg/K (105. 76 ± 60. 60)pg/ml , they are significently higher than those of the healthy control group(482. 30 ± 94. 57) ug/1, (3. 76 ±1. 75)mg/1 > (51. 34 ± 20. 14) pg/ml ( P<0.01).2. The worse of the cardiac function, the higher of the serum sICAM-1, CRP and Angll, especially the difference between cardiac function IV and II, IV and III, III and II (P<0.01) .3. There is no significent difference on sICAM-1 level before treatment between the group of conventional treatment patients and Valsartan patients ( 726.83 ± 223.58Hg/l, 746.33 ± 347.40Hg/l, respectively) (P>0. 05). There is a significant decrease of the levels of sICAM-1 in all patients ( 630. 20±180. 52Hg/l, 529.43± 187. 48Mg/l, respectively)(P<0.01), compared with those in conventional group, the sICAM-1 levels in Valsartan group are significantly lower( P<0.05).4. The serum levels of sICAM-1 in CHF patients correspond positively with those of CRP and Angll as well as cardiac function grades. Cone I us i ons1. The levels of serum sICAM-1 increase in CHF patients and are associated with the degree of CHF, the worse of the CHF function, the higher the sICAM-1. To measure the levels of serum sICAM-1 in CHF patients is helpful for evaluation the degree of heart failure.2. sICAM-1 is a marker of cardiac cell inflammation, it increases and corresponds nicely with CRP and Angll in CHF patients, indicates that there is not only a RAS stimulation but also a progress of inflammation or an immunological stimulation in CHF, which needs some advanced studies .3. By significently lowering the serum sICAM-1 of CHF patients,Valsartan may inhibit the cardiac cell inflamation and ventricular reconstruction,which helps to slow the CHF progression, improve cardiac function. We think it may be another mechanic of Valsartan in treatment of CHF .Postgraduate Yu Lingyun ( Cardiology ) Directed by Tao Zhigang...
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