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Reduction of systemic inflammation after cardiac resynchronization therapy: A new form of response?
Redução da inflamação sistémica após terapêutica de ressincronização cardíaca: uma nova forma de resposta?
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Δ CRP: variation in CRP levels.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luís Almeida-Morais, Ana Abreu, Mário Oliveira, Pedro Silva Cunha, Inês Rodrigues, Guilherme Portugal, Pedro Rio, Rui Soares, Miguel Mota Carmo, Rui Cruz Ferreira" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Luís" "apellidos" => "Almeida-Morais" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Abreu" ] 2 => array:2 [ "nombre" => "Mário" "apellidos" => "Oliveira" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Silva Cunha" ] 4 => array:2 [ "nombre" => "Inês" "apellidos" => "Rodrigues" ] 5 => array:2 [ "nombre" => "Guilherme" "apellidos" => "Portugal" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Rio" ] 7 => array:2 [ "nombre" => "Rui" "apellidos" => "Soares" ] 8 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mota Carmo" ] 9 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300588?idApp=UINPBA00004E" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300588/v1_201803200458/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Reduction of systemic inflammation after cardiac resynchronization therapy: A new form of response?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "116" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Natália António" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Natália" "apellidos" => "António" "email" => array:1 [ 0 => "natalia.antonio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Redução da inflamação sistémica após terapêutica de ressincronização cardíaca: uma nova forma de resposta?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic heart failure (CHF) is the final common pathway for various cardiac pathologies and, despite significant progress in its treatment in recent years, this complex clinical syndrome still has a poor prognosis.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cardiac resynchronization therapy (CRT) is a well-established option in the treatment of CHF that results in significant clinical improvements, ventricular reverse remodeling, and lower mortality in selected patients.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2–4</span></a> However, based on current selection criteria, a significant proportion of patients with CHF do not respond positively to CRT.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> It is therefore important to identify new predictors that will improve the selection of potential responders to this therapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the pathophysiology of CHF is still poorly understood, neurohormonal stimulation and immune activation have been shown to be involved in the development and progression of this systemic disease.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,7</span></a> There is growing evidence that levels of various pro-inflammatory cytokines are elevated in patients with CHF, and that this inflammatory response has negative prognostic implications. C-reactive protein (CRP) has been widely studied and is present at higher levels in patients with CHF than in healthy controls.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> Furthermore, high CRP levels in patients with CHF are associated with a worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">However, the impact of CRT on the progression of the systemic inflammatory status associated with CHF has been little investigated, and the scarce information available is contradictory. The study by Almeida-Morais et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span> is thus of considerable relevance.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors present a prospective cohort study involving 115 patients with advanced heart failure of different etiologies and with indication for CRT. The primary aim of the study was to assess changes in inflammatory response based on B-type natriuretic peptide (BNP) and CRP levels following CRT. The secondary aim was to determine the association between changes in inflammatory parameters and functional and echocardiographic response to CRT. The authors defined patients with a minimum increase of 10% in peak oxygen consumption as functional responders, and used the conventional definition of echocardiographic responders as those in whom a reduction of at least 15% in left ventricular end-systolic volume was seen six months after device implantation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This new study reports innovative and interesting results with regard to the behavior of the inflammatory response in patients undergoing CRT. Overall, CRT was associated with a significant reduction in plasma BNP and CRP levels, suggesting that, in addition to slowing progression of CHF, CRT may also help directly or indirectly to reduce systemic inflammation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Previous studies have assessed the impact of CRT on the systemic inflammatory response associated with CHF, showing a significant reduction in many inflammatory mediators.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10–13</span></a> In some of these studies, this reduction was only seen in CRT responders.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">14,15</span></a> However, the literature also includes other studies in which the effect of CRT on inflammatory markers was neutral, even in responders.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">16,17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors of the study observed that functional and echocardiographic responses to CRT were not correlated and that, oddly, only functional responders presented a significant post-CRT reduction in inflammatory parameters. According to these innovative results, improvement in inflammatory status may occur in response to functional improvement in CHF, even in the absence of ventricular reverse remodeling.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the limitations arising from the heterogeneity of the study population in terms of CHF etiology, which may lead to differences in immune activation, this study had the advantage of including a population under optimal pharmacological CHF therapy and with very similar clinical presentations in both responders and non-responders, by both echocardiographic and functional criteria.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We are far from fully understanding the mechanisms behind the effect of CRT on the systemic inflammatory response in CHF, and many questions remain that merit further investigation. If CRT reduces the inflammatory status of patients with CHF, what are the mechanisms underlying this improvement, and what prognostic impact could that reduction in systemic inflammation have? Moreover, can systemic inflammation determine the functional response to CRT? Can immune mechanisms also influence the ability of CRT to induce ventricular reverse remodeling?</p><p id="par0055" class="elsevierStylePara elsevierViewall">Uncertainties remain concerning the impact of CRT on systemic inflammation. However, there is increasing evidence to support the promising hypothesis of a new form of response to CRT – the reduction of inflammatory status associated with CHF.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: António N. Redução da inflamação sistémica após terapêutica de ressincronização cardíaca: uma nova forma de resposta? Rev Port Cardiol. 2018;37:115–116.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proinflammatory cytokines: predictors of a failing heart?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R. Murray" 1 => "G.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 27 | 26 | 53 |
| 2024 September | 33 | 26 | 59 |
| 2024 August | 35 | 31 | 66 |
| 2024 July | 32 | 33 | 65 |
| 2024 June | 34 | 31 | 65 |
| 2024 May | 28 | 19 | 47 |
| 2024 April | 31 | 26 | 57 |
| 2024 March | 37 | 23 | 60 |
| 2024 February | 29 | 31 | 60 |
| 2024 January | 20 | 29 | 49 |
| 2023 December | 23 | 27 | 50 |
| 2023 November | 21 | 16 | 37 |
| 2023 October | 8 | 13 | 21 |
| 2023 September | 16 | 17 | 33 |
| 2023 August | 28 | 14 | 42 |
| 2023 July | 12 | 8 | 20 |
| 2023 June | 21 | 9 | 30 |
| 2023 May | 30 | 19 | 49 |
| 2023 April | 21 | 2 | 23 |
| 2023 March | 42 | 19 | 61 |
| 2023 February | 29 | 18 | 47 |
| 2023 January | 14 | 10 | 24 |
| 2022 December | 40 | 22 | 62 |
| 2022 November | 51 | 20 | 71 |
| 2022 October | 36 | 23 | 59 |
| 2022 September | 22 | 26 | 48 |
| 2022 August | 30 | 35 | 65 |
| 2022 July | 35 | 34 | 69 |
| 2022 June | 23 | 22 | 45 |
| 2022 May | 14 | 24 | 38 |
| 2022 April | 35 | 33 | 68 |
| 2022 March | 22 | 30 | 52 |
| 2022 February | 22 | 31 | 53 |
| 2022 January | 33 | 21 | 54 |
| 2021 December | 15 | 33 | 48 |
| 2021 November | 27 | 40 | 67 |
| 2021 October | 32 | 33 | 65 |
| 2021 September | 19 | 30 | 49 |
| 2021 August | 26 | 33 | 59 |
| 2021 July | 20 | 23 | 43 |
| 2021 June | 21 | 27 | 48 |
| 2021 May | 22 | 34 | 56 |
| 2021 April | 41 | 44 | 85 |
| 2021 March | 68 | 29 | 97 |
| 2021 February | 47 | 20 | 67 |
| 2021 January | 27 | 15 | 42 |
| 2020 December | 44 | 11 | 55 |
| 2020 November | 26 | 16 | 42 |
| 2020 October | 26 | 15 | 41 |
| 2020 September | 60 | 12 | 72 |
| 2020 August | 10 | 12 | 22 |
| 2020 July | 60 | 14 | 74 |
| 2020 June | 43 | 12 | 55 |
| 2020 May | 35 | 10 | 45 |
| 2020 April | 26 | 15 | 41 |
| 2020 March | 76 | 12 | 88 |
| 2020 February | 46 | 49 | 95 |
| 2020 January | 35 | 14 | 49 |
| 2019 December | 32 | 10 | 42 |
| 2019 November | 26 | 7 | 33 |
| 2019 October | 33 | 4 | 37 |
| 2019 September | 7 | 9 | 16 |
| 2019 August | 33 | 6 | 39 |
| 2019 July | 34 | 9 | 43 |
| 2019 June | 21 | 17 | 38 |
| 2019 May | 38 | 15 | 53 |
| 2019 April | 19 | 16 | 35 |
| 2019 March | 65 | 11 | 76 |
| 2019 February | 48 | 9 | 57 |
| 2019 January | 29 | 8 | 37 |
| 2018 December | 48 | 13 | 61 |
| 2018 November | 58 | 7 | 65 |
| 2018 October | 106 | 17 | 123 |
| 2018 September | 48 | 16 | 64 |
| 2018 August | 27 | 5 | 32 |
| 2018 July | 46 | 5 | 51 |
| 2018 June | 60 | 14 | 74 |
| 2018 May | 49 | 10 | 59 |
| 2018 April | 138 | 22 | 160 |
| 2018 March | 129 | 38 | 167 |
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