| Objective Chronic heart failure (CHF) is a major public health problem in the world. It is a common condition that causes considerable morbidity and mortality. But cardiovascular physicians often have difficulties to identify if a patient really suffer from CHF, because CHF is a clinical syndrome which lack of specificity. We need lab criterion as a complement in CHF diagnosis. In recent 20 years, we have recognized neurohumoral responses to cardiac injury participate in pathogenesis of CHF. Plasma levels of neurohumoral factors and cytokine should offer an indication of cardiovascular prognosis and may aid risk stratification and choice of therapy. Historically, beta blockade was considered contraindicated in heart failure because of concerns regarding negative inotropic effects and initial worsening of symptom in patients treated with these agents. However, beta blockade produces several potentially beneficial effects, which result in clinical benefit as reflected by improvement in cardiac function, clinical symptoms as well as long-term morbidity and mortality. Carvedilol is a cardiac adrenergic receptor antagonist that is nonselective for beta-1 verse beta-2-receptors. It is also an alpha-1-receptor antagonist and this antagonism results in mild vasodilation and may have other benefits mediates through the effects of alpha-1 blockade in the heart. In this study, we want to observe the changes of TNF- a , IL-6, ANP and BNP concentration of plasma and effects of carvedilol on these changes. Meanwhile, we want to find out whether TNF- a ,IL-6,ANP and BNP concentration of plasma can predicate the outcomes of CHF and the benefits from treatment with carvedilol.Methods The subjects were divided into CHF group(n=45)and healthy control group(n=20). Patients(male=28,femal=17)of CHF group were recruited with chronic stable heart failure cause by dilated cardiomyopathy(n=20), hypertensive heartdisease(n=14) or ischemic heart disease(n=ll), left ventricular ejection fraction (LVEF) <0.50. There is no significant difference of age or sex between CHF group and control group(P>0.05). Plasma TNF- a , IL-6, ANP and BNP concentrations were measured by immunoradiometric assay immediately after admission. Severity of CHF was based on NYHA heart functional classes. LVEF and left ventricular internal dimension at end-diastole(LVED) were measured by M-mode Echocardiography. The CHF group was further subdivided into either or plus carvedilol conventionally. TNF- a , IL-6, ANP or BNP concentrations were re-checked two weeks later. LVEF and LVED were re-checked six months later.Statistics All continual variables were compared with the use of t tests; ratio comparisons were made using x 2test; correlations were analyzed by Pearson correlation; binary logistic regression were used to examine potential indicators for independent prediction of outcome event. P<0.05 was taken to indicate statistical significance.Results TNF- a, EL-6, ANP or BNP concentrations of CHF group were higher than those of control group. The concentrations increased with the severity of heart failure (P<0.01). TNF- a , IL-6, ANP or BNP concentrations of CHF group has positive correlation with LVED independently and has negative correlation with EF or FS. 10 patients who died or were readmitted tended to have an increase in their TNF- a , IL-6, ANP or BNP concentrations during the course of hospitalization; 32 patients who had successful treatment tend to have a decrease in their TNF- a , IL-6, ANP or BNP concentrations during hospitalization(P<0.01). Patients of rising TNF- a 5 DL-6, ANP or BNP concentrations shows higher ratio of end points than those of falling TNF- a , EL-6, ANP or BNP concentrations (P<0.01). As to diagnosis of CHF, these results show that the assay sensitivity is89%(ANP), 100%(BNP), 71%( TNF-a ), 62%(IL-6); sepecificityis 70%(ANP),95%(BNP), 65%( TNF- a ), 45%(IL-6); the positive predictive value is87%(ANP),98%(BNP), 82%( TNF- a ), 76%(IL-6); the negative predictive value is74%(ANP),100%(BNP), 50%( TNF-a), 79%(IL-6). Two weeks later...
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