Inflammation-Related Biomarkers Are Associated with Heart Failure Severity and Poor Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy

Inflammation-related biomarkers are associated with clinical outcomes in mixed-etiology chronic heart failure populations. Inflammation-related markers tend to be higher in ischemic than in non-ischemic dilated cardiomyopathy (NI-DCM) patients, which might impact their prognostic performance in NI-DCM patients. Therefore, we aimed to assess the association of inflammation-related biomarkers with heart failure severity parameters and adverse cardiac events in a pure NI-DCM patient cohort. Fifty-seven patients with NI-DCM underwent endomyocardial biopsy. Biopsies were evaluated by immunohistochemistry for CD3+, CD45ro+, CD68+, CD4+, CD54+, and HLA-DR+ cells. Blood samples were tested for high-sensitivity C-reactive protein (hs-CRP), interleukin-6, tumor necrosis factor-α (TNF-α), soluble urokinase-type plasminogen activator receptor and adiponectin. During a five-year follow-up, twenty-seven patients experienced at least one composite adverse cardiac event: left ventricle assist device implantation, heart transplantation or death. Interleukin-6, TNF-α and adiponectin correlated with heart failure severity parameters. Patients with higher levels of interleukin-6, TNF-α, adiponectin or hs-CRP, or a higher number of CD3+ or CD45ro+ cells, had lower survival rates. Interleukin-6, adiponectin, and CD45ro+ cells were independently associated with poor clinical outcomes. All patients who had interleukin-6, TNF-α and adiponectin concentrations above the threshold experienced an adverse cardiac event. Therefore, a combination of these cytokines can identify high-risk NI-DCM patients.

Abstract 15684: Discordance Between Severity of Heart Failure as Determined by Patient Report versus Cardiopulmonary Exercise Testing

Introduction: Although patient-reported outcomes are increasingly emphasized, symptoms may be discordant to objective parameters of heart failure severity. The frequency of such discordance, associated characteristics, and its influence on clinical outcomes is unknown. Methods: This is a post-hoc analysis of the HF-ACTION trial (N=2062). Participants were divided by median baseline values for Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ, subjective measure) and V E /VCO 2 slope (objective measure) into 4 groups: “concordant-lower severity” (high KCCQ, low V E /VCO 2 slope), “concordant-higher severity” (low KCCQ, high V E /VCO 2 slope), “symptom magnifier” (low KCCQ, V E /VCO 2 slope), and “symptom minimizer” (high KCCQ, V E /VCO 2 slope). Baseline characteristics were compared, and the relationship between group and clinical outcomes over a median follow-up of 442 days was assessed in adjusted Cox models. Results: Discordance of patient-reported and objective illness severity was common (46%). Depression was more prevalent among symptom magnifiers (N=480) versus concordant-lower severity (N=566) and symptom minimizer (N=465) groups (30%, 18%, 14%, respectively; P<0.001). Compared to concordant-lower severity participants, those who were symptom magnifiers, symptom minimizers, or concordant-higher severity were at increased risk of hospitalization (Table). Concordant-higher severity participants and symptom minimizers, but not symptom magnifiers, were at an increased risk of death versus concordant-lower severity participants. Conclusion: A high rate of discordance was observed between patient-reported and objective heart failure severity. Depression was associated with symptom magnification. Hospitalization was influenced by patient-reported severity but mortality tracked more closely with objective data, highlighting potential limitations of static patient-reported outcomes for risk stratification.

Impact of heart failure severity on ventricular assist device haemodynamics: a computational study

Purpose This computational fluid dynamics study investigates the necessity of incorporating heart failure severity in the preoperative planning of left ventricular assist device (LVAD) configurations, as it is often omitted from studies on LVAD performance. Methods A parametric study was conducted examining a common range of LVAD to aortic root flow ratios (LVAD/AR-FR). A normal aortic root waveform was scaled by 5–30% in increments of 5% to represent the common range of flow pumped by the left ventricle for different levels of heart failure. A constant flow rate from the cannula compensated for the severity of heart failure in order to maintain normal total aortic flow rate. Results The results show that LVAD/AR-FR can have a significant but irregular impact on the perfusion and shear stress-related haemodynamic parameters of the subclavian and carotid arteries. Furthermore, it is found that a larger portion of the flow is directed towards the thoracic aorta at the expense of the carotid and subclavian arteries, regardless of LVAD/AR-FR. Conclusion The irregular behaviour found in the subclavian and carotid arteries highlights the necessity of including the LVAD/AR-FR in the preoperative planning of an LVAD configuration, in order to accurately improve the effects on the cardiovascular system post implantation.