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Erschienen in: Pediatric Cardiology 8/2013

01.12.2013 | Original Article

Inflammatory Markers Are Elevated in Eisenmenger Syndrome

verfasst von: Sivasubramanian Ramakrishnan, Bharat Bhooshan Kukreti, Lakshmy Ramakrishnan, Salman Salahuddin, Amit Pendharkar, Ganesan Karthikeyan, Balram Bhargava, Rajnish Juneja, Sandeep Seth, Shyam S. Kothari, Anita Saxena, Vinay K. Bahl

Erschienen in: Pediatric Cardiology | Ausgabe 8/2013

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Abstract

Inflammation may be an important contributing factor to the progression of Eisenmenger syndrome (ES). Markers of systemic inflammation in ES have not been systematically studied. Inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), interleukin-2 (IL-2), IL-6, and interferon-γ (IFN-γ) were measured in 42 consecutive ES patients (mean age, 24.3 ± 10.6 years) compared with their levels in 22 healthy control subjects. The patients were followed up for a mean duration of 16.3 ± 13.7 months. The levels of inflammatory markers were correlated with clinical and hemodynamic variables at baseline and the outcomes of death, hospitalization, and worsening World Health Organization (WHO) functional class at follow-up evaluation. Compared with the control subjects, ES patients showed a significant elevation in hs-CRP (2.99 ± 3.5 vs 1.1 ± 0.9 mg/dl; p = 0.002) and IFN-γ (41.3 ± 43.6 vs 10.4 ± 6.9 pg/ml; p < 0.001) levels. The levels of IL-2 and IL-6 also were elevated but did not differ significantly from those in the control subjects. The patients with hs-CRP levels higher than 3 mg/dl were significantly older (28.9 ± 10.6 vs 21.5 ± 9.8 years) and had a significantly shorter 6-min walk distance (421.5 ± 133.2 vs 493.3 ± 74.8 m). The levels of inflammatory markers did not correlate with baseline parameters or clinical outcomes. To conclude, the levels of hs-CRP and IFN-γ are significantly elevated in ES. Elevated hs-CRP in ES was associated with older age and shorter 6-min walk distance, but the levels of inflammatory markers were not predictive of clinical events.
Literatur
1.
Zurück zum Zitat ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRef ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRef
2.
Zurück zum Zitat Beghetti M, Galiè N (2009) Eisenmenger syndrome: a clinical perspective in a new therapeutic era of pulmonary arterial hypertension. J Am Coll Cardiol 53:733–740CrossRefPubMed Beghetti M, Galiè N (2009) Eisenmenger syndrome: a clinical perspective in a new therapeutic era of pulmonary arterial hypertension. J Am Coll Cardiol 53:733–740CrossRefPubMed
3.
Zurück zum Zitat Cacoub P, Dorent R, Maistre G, Nataf P, Carayon A, Piette C, Godeau P, Cabrol C, Gandjbakhch I (1993) Endothelin-1 in primary pulmonary hypertension and the Eisenmenger syndrome. Am J Cardiol 71:448–450CrossRefPubMed Cacoub P, Dorent R, Maistre G, Nataf P, Carayon A, Piette C, Godeau P, Cabrol C, Gandjbakhch I (1993) Endothelin-1 in primary pulmonary hypertension and the Eisenmenger syndrome. Am J Cardiol 71:448–450CrossRefPubMed
4.
Zurück zum Zitat Caramuru LH, Lopes AA, Maeda NY, Aiello VD, Filho CC (2006) Long-term behavior of endothelial and coagulation markers in Eisenmenger syndrome. Clin Appl Thromb Hemost 12:175–183CrossRefPubMed Caramuru LH, Lopes AA, Maeda NY, Aiello VD, Filho CC (2006) Long-term behavior of endothelial and coagulation markers in Eisenmenger syndrome. Clin Appl Thromb Hemost 12:175–183CrossRefPubMed
5.
Zurück zum Zitat Cool CD, Kennedy D, Voelkel NF, Tuder RF (1997) Pathogenesis and evolution of plexiform lesions in pulmonary hypertension associated with scleroderma and human immunodeficiency virus infection. Human Pathol 28:434–442CrossRef Cool CD, Kennedy D, Voelkel NF, Tuder RF (1997) Pathogenesis and evolution of plexiform lesions in pulmonary hypertension associated with scleroderma and human immunodeficiency virus infection. Human Pathol 28:434–442CrossRef
6.
Zurück zum Zitat de P S Soares R, Maeda NY, Bydlowski SP, Lopes AA (2005) Markers of endothelial dysfunction and severity of hypoxaemia in the Eisenmenger syndrome. Cardiol Young 15:504–513CrossRefPubMed de P S Soares R, Maeda NY, Bydlowski SP, Lopes AA (2005) Markers of endothelial dysfunction and severity of hypoxaemia in the Eisenmenger syndrome. Cardiol Young 15:504–513CrossRefPubMed
7.
Zurück zum Zitat Dimopoulos K, Inuzuka R, Goletto S, Giannakoulas G, Swan L, Wort SJ, Gatzoulis MA (2010) Improved survival among patients with Eisenmenger syndrome receiving advanced therapy for pulmonary arterial hypertension. Circulation 121:20–25CrossRefPubMed Dimopoulos K, Inuzuka R, Goletto S, Giannakoulas G, Swan L, Wort SJ, Gatzoulis MA (2010) Improved survival among patients with Eisenmenger syndrome receiving advanced therapy for pulmonary arterial hypertension. Circulation 121:20–25CrossRefPubMed
8.
Zurück zum Zitat Galiè N, Beghetti M, Gatzoulis MA, Granton J, Berger RM, Lauer A, Chiossi E, Landzberg M, Bosentan Randomized Trial of Endothelin Antagonist Therapy-5 (BREATHE-5) Investigators (2006) Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study. Circulation 114:48–54CrossRefPubMed Galiè N, Beghetti M, Gatzoulis MA, Granton J, Berger RM, Lauer A, Chiossi E, Landzberg M, Bosentan Randomized Trial of Endothelin Antagonist Therapy-5 (BREATHE-5) Investigators (2006) Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study. Circulation 114:48–54CrossRefPubMed
9.
Zurück zum Zitat Humbert M, Monti G, Brenot F, Sitbon O, Portier A, Grangeot-Keros L, Duroux P, Galanaud P, Simonneau G, Emilie D (1995) Increased interleukin-1 and interleukin-6 serum concentrations in severe primary pulmonary hypertension. Am J Respir Crit Care Med 151:1628–1631CrossRefPubMed Humbert M, Monti G, Brenot F, Sitbon O, Portier A, Grangeot-Keros L, Duroux P, Galanaud P, Simonneau G, Emilie D (1995) Increased interleukin-1 and interleukin-6 serum concentrations in severe primary pulmonary hypertension. Am J Respir Crit Care Med 151:1628–1631CrossRefPubMed
10.
Zurück zum Zitat Iversen K, Jensen AS, Jensen TV, Vejlstrup NG, Søndergaard L (2010) Combination therapy with bosentan and sildenafil in Eisenmenger syndrome: a randomized, placebo-controlled, double-blinded trial. Eur Heart J 31:1124–1131CrossRefPubMed Iversen K, Jensen AS, Jensen TV, Vejlstrup NG, Søndergaard L (2010) Combination therapy with bosentan and sildenafil in Eisenmenger syndrome: a randomized, placebo-controlled, double-blinded trial. Eur Heart J 31:1124–1131CrossRefPubMed
11.
Zurück zum Zitat Jachec W, Foremny A, Domal-Kwiatkowska D, Smolik S, Tomasik A, Mazurek U, Wodniecki J (2008) Expression of TGF-beta1 and its receptor genes (TbetaR I, TbetaR II, and TbetaR III-betaglycan) in peripheral blood leucocytes in patients with idiopathic pulmonary arterial hypertension and Eisenmenger’s syndrome. Int J Mol Med 21:99–107PubMed Jachec W, Foremny A, Domal-Kwiatkowska D, Smolik S, Tomasik A, Mazurek U, Wodniecki J (2008) Expression of TGF-beta1 and its receptor genes (TbetaR I, TbetaR II, and TbetaR III-betaglycan) in peripheral blood leucocytes in patients with idiopathic pulmonary arterial hypertension and Eisenmenger’s syndrome. Int J Mol Med 21:99–107PubMed
12.
Zurück zum Zitat Jiang YW, Pang L, Fang QH, Ma YM (2011) The relationship between inflammatory mediators and pulmonary hypertension in patients with chronic obstructive pulmonary disease. Zhonghua Jie He He Hu Xi Za Zhi 34:904–908PubMed Jiang YW, Pang L, Fang QH, Ma YM (2011) The relationship between inflammatory mediators and pulmonary hypertension in patients with chronic obstructive pulmonary disease. Zhonghua Jie He He Hu Xi Za Zhi 34:904–908PubMed
13.
Zurück zum Zitat Joppa P, Petrasova D, Stancak B, Tkacova R (2006) Systemic inflammation in patients with COPD and pulmonary hypertension. Chest 130:326–333CrossRefPubMed Joppa P, Petrasova D, Stancak B, Tkacova R (2006) Systemic inflammation in patients with COPD and pulmonary hypertension. Chest 130:326–333CrossRefPubMed
14.
Zurück zum Zitat Kherbeck N, Tamby MC, Bussone G, Dib H, Perros F, Humbert M, Mouthon L (2013) The role of inflammation and autoimmunity in the pathophysiology of pulmonary arterial hypertension. Clin Rev Allergy Immunol 44:31–38CrossRefPubMed Kherbeck N, Tamby MC, Bussone G, Dib H, Perros F, Humbert M, Mouthon L (2013) The role of inflammation and autoimmunity in the pathophysiology of pulmonary arterial hypertension. Clin Rev Allergy Immunol 44:31–38CrossRefPubMed
15.
Zurück zum Zitat Lakoski SG, Cushman M, Palmas W, Blumenthal R, D’Agostino RB Jr, Herrington DM (2005) The relationship between blood pressure and C-reactive protein in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol 46:1869–1874CrossRefPubMed Lakoski SG, Cushman M, Palmas W, Blumenthal R, D’Agostino RB Jr, Herrington DM (2005) The relationship between blood pressure and C-reactive protein in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol 46:1869–1874CrossRefPubMed
16.
Zurück zum Zitat Li J, Li JJ, He JG, Nan JL, Guo YL, Xiong CM (2010) Atorvastatin decreases C-reactive protein-induced inflammatory response in pulmonary artery smooth muscle cells by inhibiting nuclear factor-kappaB pathway. Cardiovasc Ther 28:8–14CrossRefPubMed Li J, Li JJ, He JG, Nan JL, Guo YL, Xiong CM (2010) Atorvastatin decreases C-reactive protein-induced inflammatory response in pulmonary artery smooth muscle cells by inhibiting nuclear factor-kappaB pathway. Cardiovasc Ther 28:8–14CrossRefPubMed
17.
Zurück zum Zitat Lopes AA, Caramurú LH, Maeda NY (2002) Endothelial dysfunction associated with chronic intravascular coagulation in secondary pulmonary hypertension. Clin Appl Thromb Hemost 8:353–358CrossRefPubMed Lopes AA, Caramurú LH, Maeda NY (2002) Endothelial dysfunction associated with chronic intravascular coagulation in secondary pulmonary hypertension. Clin Appl Thromb Hemost 8:353–358CrossRefPubMed
18.
Zurück zum Zitat Maciocia PM (2010) Inflammatory signaling in pulmonary arterial hypertension: the controversial role of CRP, and the search for new therapies. Cardiovasc Ther 28:1–4CrossRefPubMed Maciocia PM (2010) Inflammatory signaling in pulmonary arterial hypertension: the controversial role of CRP, and the search for new therapies. Cardiovasc Ther 28:1–4CrossRefPubMed
19.
Zurück zum Zitat Mukhopadhyay S, Sharma M, Ramakrishnan S, Yusuf J, Gupta MD, Bhamri N, Trehan V, Tyagi S (2006) Phosphodiesterase-5 inhibitor in Eisenmenger syndrome: a preliminary observational study. Circulation 114:1807–1810CrossRefPubMed Mukhopadhyay S, Sharma M, Ramakrishnan S, Yusuf J, Gupta MD, Bhamri N, Trehan V, Tyagi S (2006) Phosphodiesterase-5 inhibitor in Eisenmenger syndrome: a preliminary observational study. Circulation 114:1807–1810CrossRefPubMed
20.
Zurück zum Zitat Nicolls MR, Taraseviciene-Stewart L, Rai PR, Badesch DB, Voelkel NF (2005) Autoimmunity and pulmonary hypertension: a perspective. Eur Respir J 26:1110–1118CrossRefPubMed Nicolls MR, Taraseviciene-Stewart L, Rai PR, Badesch DB, Voelkel NF (2005) Autoimmunity and pulmonary hypertension: a perspective. Eur Respir J 26:1110–1118CrossRefPubMed
21.
Zurück zum Zitat Price LC, Wort SJ, Perros F, Dorfmüller P, Huertas A, Montani D, Cohen-Kaminsky S, Humbert M (2012) Inflammation in pulmonary arterial hypertension. Chest 141:210–221CrossRefPubMed Price LC, Wort SJ, Perros F, Dorfmüller P, Huertas A, Montani D, Cohen-Kaminsky S, Humbert M (2012) Inflammation in pulmonary arterial hypertension. Chest 141:210–221CrossRefPubMed
22.
Zurück zum Zitat Ramakrishnan S, Vyas C, Kothari SS, Bhargava B, Kukreti BB, Kalaivani M, Juneja R, Seth S, Saxena A, Bahl VK (2011) Acute and short-term hemodynamic effects of metoprolol in Eisenmenger syndrome: a preliminary observational study. Am Heart J 161:938–943CrossRefPubMed Ramakrishnan S, Vyas C, Kothari SS, Bhargava B, Kukreti BB, Kalaivani M, Juneja R, Seth S, Saxena A, Bahl VK (2011) Acute and short-term hemodynamic effects of metoprolol in Eisenmenger syndrome: a preliminary observational study. Am Heart J 161:938–943CrossRefPubMed
23.
Zurück zum Zitat Sakamaki F, Kyotani S, Nagaya N, Sato N, Oya H, Satoh T, Nakanishi N (2000) Increased plasma P-selectin and decreased thrombomodulin in pulmonary arterial hypertension were improved by continuous prostacyclin therapy. Circulation 102:2720–2725CrossRefPubMed Sakamaki F, Kyotani S, Nagaya N, Sato N, Oya H, Satoh T, Nakanishi N (2000) Increased plasma P-selectin and decreased thrombomodulin in pulmonary arterial hypertension were improved by continuous prostacyclin therapy. Circulation 102:2720–2725CrossRefPubMed
24.
Zurück zum Zitat Soon E, Holmes AM, Treacy CM, Doughty NJ, Southgate L, Machado RD, Trembath RC, Jennings S, Barker L, Nicklin P, Walker C, Budd DC, Pepke-Zaba J, Morrell NW (2010) Elevated levels of inflammatory cytokines predict survival in idiopathic and familial pulmonary arterial hypertension. Circulation 122:920–927CrossRefPubMed Soon E, Holmes AM, Treacy CM, Doughty NJ, Southgate L, Machado RD, Trembath RC, Jennings S, Barker L, Nicklin P, Walker C, Budd DC, Pepke-Zaba J, Morrell NW (2010) Elevated levels of inflammatory cytokines predict survival in idiopathic and familial pulmonary arterial hypertension. Circulation 122:920–927CrossRefPubMed
25.
Zurück zum Zitat Tuder RM, Voelkel NF (1998) Pulmonary hypertension and inflammation. J Lab Clin Med 132:16–24CrossRefPubMed Tuder RM, Voelkel NF (1998) Pulmonary hypertension and inflammation. J Lab Clin Med 132:16–24CrossRefPubMed
26.
Zurück zum Zitat Tuder RM, Groves B, Badesch DB, Voelkel NF (1994) Exuberant endothelial cell growth and element of inflammation are present in plexiform lesions of pulmonary hypertension. Am J Pathol 144:275–285PubMedCentralPubMed Tuder RM, Groves B, Badesch DB, Voelkel NF (1994) Exuberant endothelial cell growth and element of inflammation are present in plexiform lesions of pulmonary hypertension. Am J Pathol 144:275–285PubMedCentralPubMed
27.
Zurück zum Zitat Windgassen EB, Funtowicz L, Lunsford TN, Harris LA, Mulvagh SL (2011) C-reactive protein and high-sensitivity C-reactive protein: an update for clinicians. Postgrad Med 123:114–119CrossRefPubMed Windgassen EB, Funtowicz L, Lunsford TN, Harris LA, Mulvagh SL (2011) C-reactive protein and high-sensitivity C-reactive protein: an update for clinicians. Postgrad Med 123:114–119CrossRefPubMed
28.
Zurück zum Zitat Wynants M, Quarck R, Ronisz A, Alfaro-Moreno E, Van Raemdonck D, Meyns B, Delcroix M (2012) Effects of C-reactive protein on human pulmonary vascular cells in chronic thromboembolic pulmonary hypertension. Eur Respir J 40(4):886–894CrossRefPubMed Wynants M, Quarck R, Ronisz A, Alfaro-Moreno E, Van Raemdonck D, Meyns B, Delcroix M (2012) Effects of C-reactive protein on human pulmonary vascular cells in chronic thromboembolic pulmonary hypertension. Eur Respir J 40(4):886–894CrossRefPubMed
29.
Zurück zum Zitat Yi ES, Kim H, Ahn H, Strother J, Morris T, Masliah E, Hansen LA, Park K, Friedman PJ (2000) Distribution of obstructive intimal lesions and their cellular phenotypes in chronic pulmonary hypertension: a morphometric and immunohistochemical study. Am J Respir Crit Care Med 162:1577–1586CrossRefPubMed Yi ES, Kim H, Ahn H, Strother J, Morris T, Masliah E, Hansen LA, Park K, Friedman PJ (2000) Distribution of obstructive intimal lesions and their cellular phenotypes in chronic pulmonary hypertension: a morphometric and immunohistochemical study. Am J Respir Crit Care Med 162:1577–1586CrossRefPubMed
30.
Zurück zum Zitat Zhang ZN, Jiang X, Zhang R, Li XL, Wu BX, Zhao QH, Wang Y, Dai LZ, Pan L, Gomberg-Maitland M, Jing ZC (2011) Oral sildenafil treatment for Eisenmenger syndrome: a prospective, open-label, multicentre study. Heart 97:1876–1881CrossRefPubMed Zhang ZN, Jiang X, Zhang R, Li XL, Wu BX, Zhao QH, Wang Y, Dai LZ, Pan L, Gomberg-Maitland M, Jing ZC (2011) Oral sildenafil treatment for Eisenmenger syndrome: a prospective, open-label, multicentre study. Heart 97:1876–1881CrossRefPubMed
Metadaten
Titel
Inflammatory Markers Are Elevated in Eisenmenger Syndrome
verfasst von
Sivasubramanian Ramakrishnan
Bharat Bhooshan Kukreti
Lakshmy Ramakrishnan
Salman Salahuddin
Amit Pendharkar
Ganesan Karthikeyan
Balram Bhargava
Rajnish Juneja
Sandeep Seth
Shyam S. Kothari
Anita Saxena
Vinay K. Bahl
Publikationsdatum
01.12.2013
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 8/2013
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-013-0715-3

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