© 2007 European Society of Cardiology
Cardiac resynchronization therapy increases plasma levels of the endogenous inotrope apelin
a Division of Cardiology 2nd Faculty of Medicine, University "La Sapienza", Sant'Andrea Hospital, Rome, Italy
b DiMA Laboratory 2nd Faculty of Medicine, University "La Sapienza", Sant'Andrea Hospital, Rome, Italy
c IRCCS Neuromed Pozzilli (IS), Italy
d Research Center, AFaR San Pietro Hospital FbF, Rome, Italy
* Corresponding author. Tel.: +39 06 33 77 55 61; fax: +39 06 33 77 50 61. E-mail address: p.francia{at}tiscali.it
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Abstract |
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Background: Cardiac resynchronization therapy (CRT) has been introduced to treat drug refractory chronic heart failure (CHF). Apelin, the endogenous ligand of the APJ receptor, is under evaluation for its potential role in human CHF pathophysiology. This study aims to assess whether biventricular pacing affects plasma apelin levels in patients with severe CHF.
Methods and results: Fourteen patients (9 men, 5 women, mean age 68±13years) undergoing biventricular pace-maker/ICD implantation were studied. Patients underwent baseline clinical and echocardiographic evaluation, and assessment of plasma apelin and NT-proBNP levels. The evaluation was repeated 48h and 9±2months after device implantation to assess the acute and chronic effects of CRT on apelin and NT-proBNP levels. Eight healthy age- and sex-matched subjects served as controls.
In CHF patients, baseline apelin levels were reduced and NT-proBNP increased compared to control subjects (apelin: 0.47±0.2 vs. 0.97±0.3ng/mL, p<0.001; NT-proBNP: 2007±114 vs. 229±72pmol/L, p<0.001). Short-term evaluation did not reveal any effect of CRT on apelin or NT-proBNP levels. By contrast, at 9±2months follow-up, CRT responders showed left ventricular reverse remodelling and an increase in ejection fraction, together with a significant increase in plasma apelin levels (0.99±0.1 vs. 0.47±0.2ng/mL, p<0.001) and decrease in NT-proBNP (938±591 vs. 2007±114pmol/L, p<0.05).
Conclusions: Long-term CRT increases plasma levels of the endogenous inotrope apelin in patients with CHF.
Key Words: Apelin • Resynchronization • Heart failure • NT-proBNP • APJ • Neurohormones
Received February 20, 2006; Revised May 1, 2006; Accepted June 15, 2006
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