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Inflammation and oxidative stress caused might lead to left ventricular diastolic and hypertension by nitric oxide synthase uncoupling systolic dysfunction in patients with

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Journal of Geriatric Cardiology 2015年第1期12卷 1-10页

作者： Zsuzsanna Szelenyi Adam Fazakas Gabor Szenasi Melinda KiSS Narcis Tegze Bertalan CsabaFekete Eszter Nagy Imre Bodo Balint Nagy attila molvarec attila Patocs Lilla Pepo Zoltan Prohatszka Andras Vereckei The Heart and Vascular Center of Semmelweis University Budapest 1122 Gaal Jozsef u. 9 Hungary 3^rd Department of Internal Medicine Semmelweis University School of Medicine Budapest 1125 Kuvolgyi fit 4 Hungary Institute of Pathophysiology Semmelweis University Budapest 1089 Nagyvarad ter 4 Hungary Department of Neurology Kftv6lgyi Clinical Group Semmelweis University Budapest 1125 Kfitvolgyi ft 4 Hungary 2^nd Department of Medicine Military Hospital Budapest 1134 R6bert K6roly krt. 44 Hungary St. Istvan and St. Laszlo Hospital St. Laszlo Hospital Campus Hematology and Stem Cell Transplantation Department Hemostasis Laboratory Budapest 1097 Gyfili flit 5-7 Hungary First Department of Obstetrics and Gynecology Semmelweis University Budapest 1085 Baross u. 27 Hungary MTA-SE Lendulet Hereditary Endocrine Tumors Research Group Budapest 1051 Szechenyi Istvan ter 9 Hungary

Objective To investigate the role of oxidative stress, inflammation, hypercoagulability and neuroendocrine activation in the transition of hypertensive heart disease to heart failure with preserved ejection fraction （HFPEF）. Methods We performed echocardiography for 112 patients （≥ 60 years old） with normal EF （18 controls and 94 with hypertension）, and determined protein carbonylation （PC）, and tetrahydrobiopterin （BH4）, C-reactive protein （CRP）, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α）, fibrinogen, plasminogen activator inhibitor type-I （PAI-I）, von Willebrand factor, chromogranin A （cGA） and B-type natriuretic peptide （BNP） levels from their blood samples. Results We found that 40% （38/94） of the patients with hypertension （HT） had no diastolic dysfunction （HTDD-）, and 60% （56/94） had diastolic dysfunction （HTDD＋）. Compared to the controls, both patient groups had increased PC and BH4, TNF-α, PAI-I and BNP levels, while the HTDD＋ group had elevated cGA and CRP levels. Decreased atrial and longitudinal left ventficular （LV） systolic and diastolic myocardial deformation （strain and strain rate） was demonstrated in both patient groups versus the control. Patients whose LV diastolic function deteriorated during the follow-up had elevated PC and IL-6 level compared to their own baseline values, and to the respective values of patients whose LV diastolic function remained unchanged. Oxidative stress, inflammation, BNP and PAI-I levels inversely correlated with LV systolic, diastolic and atrial function. Conclusions In patients with HT and normal EF, the most common HFPEF precursor condition, oxidative stress and inflammation may be responsible for LV systolic, diastolic and atrial dysfunction, which are important determinants of the transition of liT to HFPEF.

关键词： Hypertension Heart failure Inflammation Oxidative stress

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