Bin Tsukada

Incremental Prognostic Values of Serum Tenascin-C Levels With Blood B-type Natriuretic Peptide Testing at Discharge in Patients With Dilated Cardiomyopathy and Decompensated Heart Failure

BACKGROUND This study investigates the predictive value of serum tenascin-C (TN-C), which is observed at the active sites of ongoing tissue remodeling, for cardiac events of patients with dilated cardiomyopathy (DCM). METHODS AND RESULTS In this trial, 110 consecutive patients hospitalized with heart failure (HF) resulting from DCM underwent assessments of serum TN-C and plasma brain natriuretic peptide (BNP) levels at discharge and were followed up for 22.4 months. Cardiac function and hemodynamics were assessed invasively in 60 of these patients at discharge. There were 19 cardiac events (14 rehospitalizations, 3 deaths from refractory HF, and 2 sudden deaths) during follow-up. The average levels of TN-C and BNP were 73 +/- 38 ng/mL and 279 +/- 414 pg/mL, respectively. The optimal cutoff value for serum TN-C levels predicted cardiac events were >or=78.4 ng/mL, whereas BNP levels were >or=219 pg/mL. Patients with levels higher than this had significantly higher cardiac events and serum TN-C >or=78.4 ng/mL had an incremental predictive power with BNP for cardiac events. Left ventricular end-diastolic volume was significantly larger, and mean pulmonary arterial pressure was elevated in patients with serum TN-C >or=78.4 ng/mL. CONCLUSIONS The combined index of serum levels for TN-C and BNP at discharge predicts cardiac events from decompensated HF. Additionally, elevated serum TN-C levels reflect left ventricular and pulmonary vascular remodeling in DCM patients.

Suppression of inflammation in rat autoimmune myocarditis by S100A8/A9 through modulation of the proinflammatory cytokine network

S100A8/A9 is expressed in activated monocytes/macrophages and assumed to be heavily involved in the pathogenesis of acute inflammation. Although several studies have asserted that S100A8/A9 has a proinflammatory function, the exact biological function of S100A8/A9 is yet to be described. We examined the anti‐inflammatory effects of S100A8/A9 on experimental autoimmune myocarditis (EAM) in rats.

High prevalence of chronic myocarditis in dilated cardiomyopathy referred for left ventriculoplasty: expression of tenascin C as a possible marker for inflammation ☆

The objectives of this study were to analyze the incidence of chronic myocarditis in dilated cardiomyopathy and to evaluate the diagnostic value of tenascin C for assessing inflammatory activity in the resected myocardium. Dilated cardiomyopathy patients with chronic myocarditis have a poor clinical outcome despite recent advances in medical treatments. Therefore, a precise diagnosis of inflammatory activity is critical to ensuring appropriate therapy. Tenascin C is an extracellular matrix glycoprotein that plays an important role in tissue remodeling in various heart diseases. Myocardial samples obtained during left ventriculoplasty from 64 patients (50 +/- 13 years, 56 men and 8 women) with dilated cardiomyopathy were examined by immunostaining for tenascin C. Histologic diagnosis was based on the Dallas criteria modified by the International Society and Federation of Cardiology task force. Nine cases (14%) had active myocarditis, 21 (33%) had borderline myocarditis, and 34 (53%) had no myocarditis. Intense tenascin C expression was observed at the site of active inflammation, with abundant cell accumulation, and in organized granulation tissue during the resolving phase but not in scar tissue during the healing phase. The ratio of tenascin C-positive area to the whole myocardium in the active and borderline myocarditis groups was significantly greater than that in the noninflammatory group. These findings suggest a high prevalence of chronic myocarditis in dilated cardiomyopathy patients and that tenascin C may prove to be a useful marker for distinguishing inflammatory cardiomyopathy from other types of dilated cardiomyopathy.