BACKGROUND: Cardiac resynchronization therapy (CRT) nonresponse remains a major clinical problem. Autoantibodies specific for the β1-adrenergic (β1-AAbs) and muscarinic (M2-AAbs) receptors are found in patients with chronic heart failure (HF) of various etiologies. MATERIALS AND METHODS: We retrospectively analyzed 73 HF patients (median age 67 years, 84% males, New York Heart Association II-IV, in sinus rhythm, left ventricular ejection fraction <35%) who received CRT defibrillator (CRT-D) from 2010 to 2013. β1-AAbs and M2-AAbs were measured by enzyme-linked immunosorbent assay. Echocardiography was used to assess CRT response (reduction >15% in left ventricular end-systolic volume at 6 months follow-up). Renal function (RF) parameters (creatinine [Cr], blood urea nitrogen [BUN], estimated glomerular filtration rate [eGFR Modified Diet in Renal Disease], cystatin C [Cys-C], and neutrophil gelatinase-associated lipocalin [NGAL]) were also evaluated. RESULTS: A significantly higher percentage of patients positive for β1-AAbs (OD sample/OD reference ratio >2.1) in nonresponders than in responder patients was observed (57% vs 27%, P = 0.004). No influence of M2-AAbs on CRT-D response was demonstrated. β1-AAbs were predictive of a poor CRT-D response (odds ratio [OR] [95% confidence interval (CI)] 3.64 [1.49-8.88], P = 0.005), also after adjustment for RF parameters (OR [95% CI] 4.95 [1.51-16.26], P = 0.008) observed to influence CRT-D response (Cr P = 0.03, BUN P = 0.009, Cys-C P = 0.02). The positive rates of β1-AABs in patients with abnormal blood level of Cr, eGFR, Cys-C, and NGAL were significantly higher than those with normal levels (P = 0.03, P = 0.02, P = 0.001, P = 0.007, respectively). CONCLUSIONS: Our study suggests that (1) the evaluation of β1-AAb is useful to identify responders to CRT-D; (2) the presence of β1-AAbs is in relationship with elevated renal function parameters.

Autoantibodies against β1-Adrenergic Receptors: Response to Cardiac Resynchronization Therapy and Renal Function / Michelucci, Antonio; D'Elios, Mario Milco; Sticchi, Elena; Pieragnoli, Paolo; Ricciardi, Giuseppe; Fatini, Cinzia; Benagiano, Marisa; Niccolai, Elena; Grassi, Alessia; Attanà, Paola; Nesti, Martina; Grifoni, Gino; Padeletti, Luigi; Abbate, Rosanna; Prisco, Domenico. - In: PACING AND CLINICAL ELECTROPHYSIOLOGY. - ISSN 0147-8389. - STAMPA. - 39:(2016), pp. 65-72. [10.1111/pace.12757]

Autoantibodies against β1-Adrenergic Receptors: Response to Cardiac Resynchronization Therapy and Renal Function

MICHELUCCI, ANTONIO;D'ELIOS, MARIO MILCO;STICCHI, ELENA;PIERAGNOLI, PAOLO;RICCIARDI, GIUSEPPE;FATINI, CINZIA;BENAGIANO, MARISA;NICCOLAI, ELENA;GRASSI, ALESSIA;ATTANA', PAOLA;NESTI, MARTINA;PADELETTI, LUIGI;ABBATE, ROSANNA;PRISCO, DOMENICO
2016

Abstract

BACKGROUND: Cardiac resynchronization therapy (CRT) nonresponse remains a major clinical problem. Autoantibodies specific for the β1-adrenergic (β1-AAbs) and muscarinic (M2-AAbs) receptors are found in patients with chronic heart failure (HF) of various etiologies. MATERIALS AND METHODS: We retrospectively analyzed 73 HF patients (median age 67 years, 84% males, New York Heart Association II-IV, in sinus rhythm, left ventricular ejection fraction <35%) who received CRT defibrillator (CRT-D) from 2010 to 2013. β1-AAbs and M2-AAbs were measured by enzyme-linked immunosorbent assay. Echocardiography was used to assess CRT response (reduction >15% in left ventricular end-systolic volume at 6 months follow-up). Renal function (RF) parameters (creatinine [Cr], blood urea nitrogen [BUN], estimated glomerular filtration rate [eGFR Modified Diet in Renal Disease], cystatin C [Cys-C], and neutrophil gelatinase-associated lipocalin [NGAL]) were also evaluated. RESULTS: A significantly higher percentage of patients positive for β1-AAbs (OD sample/OD reference ratio >2.1) in nonresponders than in responder patients was observed (57% vs 27%, P = 0.004). No influence of M2-AAbs on CRT-D response was demonstrated. β1-AAbs were predictive of a poor CRT-D response (odds ratio [OR] [95% confidence interval (CI)] 3.64 [1.49-8.88], P = 0.005), also after adjustment for RF parameters (OR [95% CI] 4.95 [1.51-16.26], P = 0.008) observed to influence CRT-D response (Cr P = 0.03, BUN P = 0.009, Cys-C P = 0.02). The positive rates of β1-AABs in patients with abnormal blood level of Cr, eGFR, Cys-C, and NGAL were significantly higher than those with normal levels (P = 0.03, P = 0.02, P = 0.001, P = 0.007, respectively). CONCLUSIONS: Our study suggests that (1) the evaluation of β1-AAb is useful to identify responders to CRT-D; (2) the presence of β1-AAbs is in relationship with elevated renal function parameters.
2016
39
65
72
Goal 3: Good health and well-being for people
Michelucci, Antonio; D'Elios, Mario Milco; Sticchi, Elena; Pieragnoli, Paolo; Ricciardi, Giuseppe; Fatini, Cinzia; Benagiano, Marisa; Niccolai, Elena; Grassi, Alessia; Attanà, Paola; Nesti, Martina; Grifoni, Gino; Padeletti, Luigi; Abbate, Rosanna; Prisco, Domenico
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1016506
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