Biventricular versus right ventricular pacing decreases immune activation and augments nitric oxide production in patients with chronic heart failure

doi:10.1016/j.ejheart.2005.12.001

European Journal of Heart Failure 2006 8(6):615-620; doi:10.1016/j.ejheart.2005.12.001

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Biventricular versus right ventricular pacing decreases immune activation and augments nitric oxide production in patients with chronic heart failure

Andrzej Rubaj^a^,*, Piotr Ruci $n$ ski^a, Konrad Rejdak^b^,d, Krzysztof Oleszczak^a, Dariusz Duma^c, Pawe $l$ Grieb^d and Andrzej Kutarski^a

^a Department of Cardiology, Medical University of Lublin Poland
^b Department of Neurology, Medical University of Lublin Poland
^c Department of Clinical Biochemistry, Medical University of Lublin Poland
^d Department of Experimental Pharmacology, Medical Research Center of the Polish Academy of Sciences Warsaw, Poland

^* Corresponding author. E-mail address:arubaj{at}yahoo.com (A. Rubaj).

Abstract

Introduction: Immune system activation and oxidative stress are involved inthe pathogenesis of heart failure (HF). We aimed to test thehypothesis that upgrading from right ventricular pacing (RVp)to biventricular pacing (BiVp) can counteract these phenomena.

Methods: 28 HF patients, with BiVp were switched to RVp for one week,and then returned to BiVp. Immediately prior to, and 48 h afterthe return to BiVp, left ventricular (LV) systolic functionwas evaluated by echocardiography, and serum N-terminal pro-brainnatriuretic peptide (NTproBNP), C-reactive protein (CRP), tumornecrosis factor alpha (TNF- ${alpha}$ ), interleukin 6 (IL6), nitric oxidemetabolites (NO_x) and malondialdehyde (MDA) were assayed.

Results: LV systolic function significantly improved 48 h after switchingfrom RVp to BiVp: Ao-VTI (p < 0.001), SV (p < 0.001) andCO (p < 0.001), and mitral regurgitation significantly decreased(p = 0.003). At the same time, indices of peripheral immuneactivation decreased: TNF- ${alpha}$ (p = 0.02) and IL6 (p < 0.001).MDA decreased (p < 0.001), whereas NO_x increased (p = 0.04).NTproBNP and CRP did not change. In addition, in "responders"(i.e. CO increase > 10% during BiVp vs. RVp) NTproBNP decreasedand NO_x increased. However, during BiVp, the decreases in TNF- ${alpha}$ ,IL6, and MDA occurred both in responders and in non-respondersand were accompanied by a reduction in mitral regurgitation.

Conclusion: The beneficial effect of BiVp compared to RVp extends beyondimproving cardiac haemodynamics and comprises a decrease inimmune activation accompanied by an increase in serum NO_x anddecrease in serum MDA.

Key Words: Biventricular pacing • Chronic heart failure • TNF • IL6 • Nitric oxide

Received April 29, 2005; Revised September 21, 2005; Accepted December 5, 2005

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