Complement activation products in acute heart failure: Potential role in pathophysiology, responses to treatment and impacts on long-term survival

Background: Previous studies have indicated a correlation between heart failure, inflammation and poorer outcome. However, the pathogenesis and role of inflammation in acute heart failure (AHF) is incompletely studied and understood. The aim of our study was to explore the potential role of innate immunity – quantified by complement activation products (CAPs) – in pathophysiology, responses to treatment and impacts on long-term survival in AHF. Methods: In a prospective study enrolling 179 unselected patients with AHF, plasma concentrations of C4d, C3a and sC5b-9 were measured in a blinded fashion on the first day of hospitalisation and prior to discharge. The final diagnosis, including the AHF phenotype, was adjudicated by two independent cardiologists. Long-term follow-up was obtained. Findings in AHF were compared to that obtained in 75 healthy blood donors (control group). Results: Overall, concentrations of all three CAPs were significantly higher in patients with AHF than in healthy controls (all p < 0.001). In an age-adjusted subgroup analysis, significant differences could be confirmed for concentrations of C4d and sC5b-9, and these parameters further increased after 6 days of in-hospital treatment ( p < 0.001). In contrast, C3a levels in AHF patients did not differ from those of the control group in the age-adjusted subgroup analysis and remained constant during hospitalisation. Concentrations of C4d, C3a and sC5b-9 were significantly higher when AHF was triggered by an infection as compared to other triggers ( p < 0.001). In addition, CAP levels significantly correlated with each other ( r = 0.64–0.76), but did not predict death within 2 years. Conclusions: Activation of complement with increased plasma levels of C4d and sC5b-9 at admission and increasing levels during AHF treatment seems to be associated with AHF, particularly when AHF was triggered by an infection. However, CAPs do not have a prognostic value in AHF.

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108 Long term pronostic role of lipoprotein-associated phospholipase A2 levels in patients with acute heart failure without acute coronary syndrome

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(11)70110-0 ◽

2011 ◽

Vol 3 (1) ◽

pp. 35

Author(s):

Jean-Christophe Charniot ◽

Randa Bittar ◽

Jean-Paul Albertini ◽

P. Giral ◽

C. Cherfils ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Phospholipase A2 ◽

Acute Heart Failure ◽

Coronary Syndrome

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Long-term survival after hospitalization for acute heart failure — Differences in prognosis of acutely decompensated chronic and new-onset acute heart failure

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.09.128 ◽

2013 ◽

Vol 168 (1) ◽

pp. 458-462 ◽

Cited By ~ 49

Author(s):

Johan P.E. Lassus ◽

Krista Siirilä-Waris ◽

Markku S. Nieminen ◽

Jukka Tolonen ◽

Tuukka Tarvasmäki ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Term Survival ◽

Long Term Survival ◽

New Onset

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Determination of a predictive cutoff value of NT-proBNP testing for long-term survival in ED patients with acute heart failure

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2013.08.033 ◽

2013 ◽

Vol 31 (12) ◽

pp. 1634-1637 ◽

Cited By ~ 7

Author(s):

Yalcin Velibey ◽

Yalcin Golcuk ◽

Burcu Golcuk ◽

Deniz Oray ◽

Ozge Duman Atilla ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Term Survival ◽

Cutoff Value ◽

Long Term Survival

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Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.120.008166 ◽

2021 ◽

Vol 14 (6) ◽

Author(s):

Pedro Caravaca Pérez ◽

Jorge Nuche ◽

Laura Morán Fernández ◽

David Lora ◽

Zorba Blázquez-Bermejo ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Potential Role ◽

Stress Test ◽

Adverse Outcomes ◽

Sample Median ◽

Diuretic Treatment ◽

Diuretic Response ◽

Worse Prognosis

Background: Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization. Methods: Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0–9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST. Results: Median UNa after FST in the 65 patients included was 113 (97–122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P =0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa; P <0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months. Conclusions: Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.

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Long-Term Survival and Intracellular Replication of Mycoplasma hominis in Trichomonas vaginalis Cells: Potential Role of the Protozoon in Transmitting Bacterial Infection

Infection and Immunity ◽

10.1128/iai.73.2.1180-1186.2005 ◽

2005 ◽

Vol 73 (2) ◽

pp. 1180-1186 ◽

Cited By ~ 38

Author(s):

Daniele Dessì ◽

Giuseppe Delogu ◽

Eleonora Emonte ◽

Maria Rosaria Catania ◽

Pier Luigi Fiori ◽

...

Keyword(s):

Defense Mechanisms ◽

Trichomonas Vaginalis ◽

Potential Role ◽

Mycoplasma Hominis ◽

Human Infection ◽

Human Pathogens ◽

Double Immunofluorescence ◽

Term Survival

ABSTRACT The existence of a symbiotic relationship between Trichomonas vaginalis and Mycoplasma hominis, which is the first reported example of symbiosis between two obligate human pathogens, has been recently reported by our research group. In this work, we examined the cellular location of M. hominis in respect to T. vaginalis. By using gentamicin protection assays, double immunofluorescence, and confocal microscopy, we obtained strong evidence that M. hominis is located within protozoan cells. 5-Bromodeoxyuridine incorporation assays showed that intracellularly located mycoplasmas actively synthesize DNA. Our results demonstrate that M. hominis has the capability of entering trichomonad cells and of replicating inside the protozoon. These findings suggest that symbiosis might provide the bacteria, during human infection, with the capability to resist to environmental stresses, such as host defense mechanisms and pharmacological therapies.

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