Karla Kurrelmeyer

THE ROLE OF CYTOKINES IN THE FAILING HUMAN HEART

Despite repeated attempts to develop a unifying hypothesis that explains the clinical syndrome of heart failure, no single conceptual paradigm has withstood the test of time. In this regard, recent studies have shown that a class of biologically active molecules, generically referred to as cytokines, are overexposed in heart failure. This article will review recent clinical and experimental material that suggest proinflammatory (stress activated) cytokines such as tumor necrosis factor-alpha (TFN-alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) may play a role in the pathogenesis of congestive heart failure. The scope of this article includes an overview of the biology of cytokines in the heart, as well as review of the clinical studies that have documented elevated levels of cytokines and cytokine receptors in patients with heart failure.

The role of cytokines in disease progression in heart failure.

Recent studies have identified the importance of biologically active molecules such as neurohormones as mediators of disease progression in heart failure. More recently it has become apparent that in addition to neurohormones, another portfolio of biologically active molecules, termed cytokines, are also expressed in the setting of heart failure. This article reviews recent clinical and experimental material that suggests that the cytokines, much like the neurohormones, may represent another class of biologically active molecules that are responsible for the development and progression of heart failure.

Safety of Contrast Administration for Endocardial Enhancement During Stress Echocardiography Compared With Noncontrast Stress

The aim was to evaluate the safety of stress echocardiography using contrast (CE) for endocardial enhancement compared with a noncontrast (NCE) cohort in a large nonselect population. The recent Food and Drug Administration warning cited lack of data for safety regarding the use of contrast in conjunction with stress echocardiography. A detailed record review was performed for 5,069 consecutive patients who underwent stress echocardiography (58% pharmacologic, 42% exercise) during an 8-year period. Contrast use, hemodynamics, and adverse clinical and electrocardiographic events were evaluated until time of discharge from the laboratory. Contrast was administered to 2,914 patients (58%) and was higher in in-patients (66%) and during dobutamine stress (67%). Compared with the NCE group, the CE group was older (median age 61 vs 58 years) and had more depressed left ventricular ejection fraction <50% (14% vs 11%; all p <0.001). The CE group experienced more chest pain (11% vs 8%; p = 0.001), back pain (0.6% vs 0.05%; p <0.001), and premature ventricular contractions (odds ratio 1.42, 95% confidence interval 1.19 to 1.69, p <0.001). There was no sustained ventricular tachycardia, ventricular fibrillation, cardiac arrest, or death in either group. One uncomplicated acute myocardial infarction and 1 anaphylactoid reaction occurred in the CE group, and none occurred in the NCE group (p = 0.51). Rates of clinically significant arrhythmias were similar in both groups (CE 2.1% vs NCE 1.9%; p = 0.8). In conclusion, although CE of echocardiographic images was used more often in patients with a higher cardiac risk profile, the risk of major adverse events was very small in both the CE and NCE stress echocardiography cohorts.

Noninvasive evaluation of women with coronary artery disease

Coronary artery disease (CAD) is the leading cause of death in women. More women than men die of CAD each year, and unlike men, the death rate has not declined for women but has remained stable over the last 20 years. Despite these statistics, much less is known about the prevention, diagnosis, or treatment of CAD in women. The noninvasive diagnosis of CAD in women is difficult secondary to differences in physiology, etiology, presenting symptoms, risk factor prevalence, comorbid conditions, hormonal status, and body habitus between women and men. Echocardiography and Tc-99m sestamibi single photon emission computed tomography imaging are two noninvasive imaging techniques commonly combined with exercise or pharmacologic agents (dobutamine, adenosine, dipyridamole) that have recently evolved to address these differences. These evolutions and the role of both techniques in the diagnosis and prognosis of women with CAD will be reviewed in this article.