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216-66: Do cardiac resynchronization and exercise training program influence inflammatory response in heart failure patients?

2016; Oxford University Press; Volume: 18; Issue: suppl_1 Linguagem: Inglês

10.1093/europace/18.suppl_1.i158a

1532-2092

Inês Rodrigues, Ana Abreu, L Almeida Morais, Vanessa Santos, Pedro Silva Cunha, Mario Oliveira, Guilherme Portugal, Matheus Rocha de Seixas Nogueira, Rui Cruz Ferreira,

Viral Infections and Immunology Research

Background: Heart failure (HF) progression is deeply influenced by inflammation and apoptosis. Nonpharmacological therapies, like Cardiac Resynchronization Therapy (CRT) and Exercise Training (EXT) are aimed to ameliorate functional capacity and induce reverse remodeling, but its effect on the inflammatory process and apoptosis need further investigation. Tumor Necrosis Factor-alpha (TNF-α) over expression had been associated with maladaptive cardiac response, including contractile dysfunction, myocite apoptosis and extracellular matrix remodeling. Aim: To evaluate the effect of CRT and EXT on inflammatory response and apoptosis modification in HF patients (P). Methods: From a cohort of 121 HF P submitted to CRT, 50 P were included in the study. P were randomized for EXT (22 P) or for control group (28 P), based on age, gender, etiology and left ventricular ejection fraction. Blood samples were collected immediately before (M0) and at 3 (M3) and 6 months (M6) after CRT, in order to evaluate the serum levels of TNF-α. Results: 22 P were submitted to EXT, 72.3% male, mean age 67 ± 10 years old, 41% with ischemic cardiomyopathy. 77.3% and 4.5% of P were in class III and IV of NYHA, respectively, and the mean left ventricular ejection fraction was 27 ± 6%. Baseline TNF-α was 2.69 ± 1.79pg/ml for the study population, with no significant difference between EXT and control groups (p = 0.486). In CRT patients who performed EXT, there was a significant reduction in TNF-α levels from M0 (2.95 ± 2.1 pg/ml) to M6 (1.73 ± 0.9 pg/ml) (ΔTNF-α M6-M1 = -1.08 ± 1.3pg/ml, p = 0.016). In CRT patients who did not perform EXT, the TNF-α levels did not change significantly (ΔTNF-α M6-M1 = 0.12 ± 0.6 pg/ml, p = 0.414). The ΔTNF-α reach statistic significance between groups (p = 0.008). Conclusions: In this cohort of HF patients, it was demonstrated a significant improvement in the inflammatory status after CRT only in patients included in exercise training programs. Additional benefit of exercise on inflammatory response and apoptosis after CRT in heart failure patients may be expected.