The Interleukin-1 Axis and Risk of Death in Patients With Acutely Decompensated Heart Failure
Por:
Pascual-Figal, DA, Bayes-Genis, A, Asensio-Lopez, MC, Hernandez-Vicente, A, Garrido-Bravo, I, Pastor-Perez, F, Diez, J, Ibanez, B and Lax, A
Publicada:
12 mar 2019
Categoría:
Cardiology and cardiovascular medicine
Resumen:
BACKGROUND Soluble ST2 (sST2), which is the soluble form of interleukin (IL)-1 receptor-like 1, identifies risk in acutely decompensated heart failure (ADHF). IL-1 beta is an inflammatory cytokine that has deleterious effects in myocardial remodeling and function. IL-1 beta inhibition has beneficial effects after acute myocardial infarction. However, the role of IL-1 beta in ADHF and its relationship to ST2 remain unclear.
OBJECTIVES This study sought to investigate the relationship between IL-1 beta and sST2, and the prognostic impact of such a relationship in patients with ADHF. METHODS This study examined 316 consecutive patients who were hospitalized with ADHF (72 +/- 12 years of age, 57% male, and left ventricular ejection fraction 45 +/- 17%). Blood samples were collected at presentation, and IL-1 beta and sST2 levels were measured. All-cause mortality was obtained for all patients at 1 year.
RESULTS The IL-1 beta concentration at presentation was associated with prior HF hospitalizations, functional impairment, and higher N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T concentrations. IL-1 beta was higher in patients who died during the year after hospitalization (n = 52, 16.5%) (p = 0.005), and the optimal threshold was identified with levels over 49.1 pg/ml (hazard ratio: 2.5; 95% confidence interval: 1.43 to 4.49; p = 0.0014). Circulating IL-1 beta positively correlated with sST2 (r = 0.65; p < 0.001). Considering the prognostic thresholds of IL-1 beta (>= 49.1 pg/ml) and sST2 (>= 35.0 ng/ml) concentrations: all patients with low sST2 also presented with low IL-1 beta; among patients with high sST2, only those with also high IL-1 beta had a significantly higher risk of death (30% vs. 14%; hazard ratio: 2.52; 95% confidence interval: 1.40 to 4.56; p = 0.002).
CONCLUSIONS Circulating IL-1 beta concentrations are clinically meaningful in ADHF patients and interplay with the predictive ability of sST2. IL-1 axis-related inflammation signaling may represent a therapeutic target in ADHF. (c) 2019 by the American College of Cardiology Foundation.
Filiaciones:
Pascual-Figal, DA:
Univ Murcia, IMIB Arrixaca, Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
CNIC, Madrid, Spain
CIBERCV, Madrid, Spain
:
CIBERCV, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Heart Inst, Badalona, Spain
Asensio-Lopez, MC:
Univ Murcia, IMIB Arrixaca, Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
Hernandez-Vicente, A:
Univ Murcia, IMIB Arrixaca, Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
Garrido-Bravo, I:
Univ Murcia, IMIB Arrixaca, Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
Pastor-Perez, F:
Univ Murcia, IMIB Arrixaca, Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
Diez, J:
CIBERCV, Madrid, Spain
Univ Navarra Clin, Dept Nephrol, Pamplona, Spain
Univ Navarra Clin, Dept Cardiol & Cardiac Surg, Pamplona, Spain
Univ Navarra, Ctr Appl Med Res, Program Cardiovasc Dis, Pamplona, Spain
IDISNA, Inst Invest Sanitaria Navarra, Pamplona, Spain
Ibanez, B:
CNIC, Madrid, Spain
CIBERCV, Madrid, Spain
Univ Hosp, Fdn Jimenez Diaz, IIS, Madrid, Spain
Lax, A:
Univ Murcia, IMIB Arrixaca, Hosp Virgen de la Arrixaca, Dept Cardiol, Murcia, Spain
Green Accepted
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