Article

Endotoxin and immune activation in chronic heart failure: a prospective cohort study.

Cardiac Medicine, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
The Lancet (impact factor: 38.28). 05/1999; 353(9167):1838-42. DOI:10.1016/S0140-6736(98)09286-1 pp.1838-42
Source: PubMed

ABSTRACT Immune activation in patients with chronic heart failure may be secondary to endotoxin (lipopolysaccharide) action. We investigated the hypothesis that altered gut permeability with bacterial translocation and endotoxaemia would be increased in patients with oedema secondary to congestive heart failure.
We compared 20 patients who had chronic heart failure with recent-onset peripheral oedema (mean age 64 years [SD 10], New York Heart Association [NYHA] class 3.3 [0.7]), 20 stable non-oedematous patients with chronic heart failure (mean age 63 years [19], NYHA class 2.6 [0.7]), and 14 healthy volunteers (mean age 55 years [16]). Biochemical markers of endotoxaemia, inflammation, and immune activation were measured. Ten patients were studied within 1 week of complete resolution of oedema. Five patients survived longer than 6 months and were restudied again after remaining free of oedema for more than 3 months.
Mean endotoxin concentrations were higher in oedematous patients with chronic heart failure than in stable patients with chronic heart failure (0.74 [SD 0.45] vs 0.37 EU/mL [0.23], p=0.0009) and controls (0.46 EU/mL [0.21], p=0.02). Oedematous patients had the highest concentrations of several cytokines. After short-term diuretic treatment, endotoxin concentrations decreased from 0.84 EU/mL [0.49] to 0.45 EU/mL [0.21], p<0.05) but cytokines remained raised. After freedom of oedema for more than 3 months after oedema resolved, endotoxin concentrations remained unchanged from the previous visit (0.49 EU/mL [0.06], p=0.45).
Raised concentrations of endotoxin and cytokines are found in patients with chronic heart failure during acute oedematous exacerbation. Intensified diuretic treatment can normalise endotoxin concentrations. Our preliminary findings suggest that endotoxin may trigger immune activation in patients with chronic heart failure during oedematous episodes.

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Keywords

1 week
 
14 healthy volunteers
 
20 patients
 
20 stable non-oedematous patients
 
3 months
 
6 months
 
acute oedematous exacerbation
 
age 55 years
 
age 63 years
 
altered gut permeability
 
chronic heart failure
 
congestive heart failure
 
Immune activation
 
Intensified diuretic treatment
 
oedema secondary
 
oedematous episodes
 
oedematous patients
 
recent-onset peripheral oedema
 
short-term diuretic treatment
 
stable patients