Reduced cardiac remodelling and prevention of glutathione deficiency after omega-3 supplementation in chronic heart failure

SummaryChronic heart failure (CHF) is characterised by activation of neuroendocrine and inflammatory pathways, and both are linked to a prothrombotic state. Treatment with omega-3 polyunsaturated fatty acids (n3-PUFA) showed significant benefits including mortality reduction in CHF, but exact mechanisms of action are still unclear. We investigated the effects of n3-PUFA on markers of platelet activation and thrombogenesis in patients with severe CHF. Thirty-six patients with non-ischaemic CHF (LVEF<35%, NYHA class>2) under optimised therapy were randomised to supplementation with 1g/day or 4g/day n3-PUFA, or placebo for 12 weeks. Using whole-blood flow cytometry, monocyteplatelet aggregates characterised by CD14+/CD42b+ co-expression and monocytic tissue factor (TF) were determined. Plasma levels of P-selectin, sCD40L, fibrinogen, prothrombin fragment F1.2, TF and proinflammatory markers (high sensitive[hs] interleukin-6, hsCRP, hsTNFalpha, monocyte chemotactic protein-1) were measured by immunoassay. Supplementation with 1g/day and 4g/day n3-PUFA but not placebo significantly reduced monocyte-platelet aggregates in a dose-dependent manner (p for trend=0.02 across the groups). A dose of 4g/day but not 1g/day n3-PUFA significantly decreased P-selectin (p=0.03). Plasma TF decreased dose-dependently upon n3-PUFA supplementation (p for trend=0.02), paralleled by a significant decrease of TF+-monocytes (p for trend=0.01). The amount of 4g/day n3-PUFA exhibited modest anti-inflammatory effects with a significant reduction of hs interleukin-6 (p<0.01) and a trend-wise reduction of hsTNF-alpha (p=0.09). No changes were seen for sCD40L, fibrinogen, hsCRP and monocyte chemotactic protein-1, while F1.2 was decreased by 4g/day n3-PUFA (P=0.03). In patients with severe non-ischaemic CHF, treatment with n3-PUFA leads to a dose-dependent decrease of platelet activation and TF. Higher dosage exhibits also anti-inflammatory effects.* ClinicalTrials.gov registration number: NCT00149409

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Should We Start Prescribing Omega-3 Polyunsaturated Fatty Acids in Chronic Heart Failure?

Current Heart Failure Reports ◽

10.1007/s11897-011-0073-5 ◽

2011 ◽

Vol 9 (1) ◽

pp. 8-13 ◽

Cited By ~ 3

Author(s):

Tara K. Jarreau ◽

John H. Lee ◽

Carl J. Lavie ◽

Hector O. Ventura

Keyword(s):

Heart Failure ◽

Fatty Acids ◽

Chronic Heart Failure ◽

Polyunsaturated Fatty Acids ◽

Omega 3

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SCORING SCALE FOR ASSESSING THE RISK OF DETECTING RIGHT VENTRICLE DIASTOLIC DYSFUNCTION OF TYPE II IN CHRONIC HEART FAILURE

Vestnik of Vitebsk State Medical University ◽

10.22263/2312-4156.2021.2.77 ◽

2021 ◽

Vol 20 (2) ◽

pp. 77-87

Author(s):

O.M. Zherko ◽

◽

E.I. Shkrebneva ◽

P.D. Novikov ◽

A.S. Babenka ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Right Ventricle ◽

Diastolic Dysfunction ◽

Left Ventricular ◽

Cardiac Remodelling ◽

Left Ventricular Ejection ◽

Lateral Part ◽

Type Ii ◽

Ventricular Ejection Fraction

Odjectives. To develop a scoring scale for assessing the risk of detecting right ventricle (RV) diastolic dysfunction (DD) of type II in chronic heart failure (CHF). Material and methods. In 2017-2018, a clinical and instrumental examination of 247 patients aged 40-86 years was performed on the basis of Health Care Institution «The 1st City Clinical Hospital» in Minsk, in 2019-2020, 129 patients at the age of 39-84 years were examined in the State Institution «Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology». Study inclusion criteria: sinus rhythm, essential arterial hypertension (AH), chronic ischemic heart disease (IHD), CHF, informed voluntary consent of the patient to participate in the study. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or replacement, congenital heart defects, acute and chronic diseases of the lungs and kidneys. Results. The sum of points>52 obtained using a scoring scale that includes scientifically based ultrasound criteria for global cardiac remodelling: RV early diastolic filling index E/eʹ >4.08 (sensitivity (S) 81.1%, specificity (Sp) 56.9%) - 15 points, the amplitude of the systolic displacement of the lateral part of the tricuspid annulus in systole to the apex (TAPSE) ≤20 mm (S 74.1%, Sp 83.3%) - 49 points, pulmonary artery systolic pressure ˃32.6 mm Hg (S 85.2%, Sp 79.5%) - 31 points, indicates a high risk of detecting RV DD of type II in CHF (AUC 0.99, S 93.9%, Sp 100.0%). The reproducibility of the results is shown in an independent examination sample of patients with CHF with preserved left ventricular ejection fraction. (AUC 0.99, S 90.0%, Sp 100%, +PV 100.0%, - PV 34.5% with a cut-off threshold >52). Conclusions.When using the scale, the score is > 52, it is recommended to perform a comprehensive targeted assessment of global cardiac remodelling to determine RV DD of type II in a patient with CHF, complicating essential AH, chronic IHD.

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