1. Chemokine receptor patterns and right heart failure in mechanical circulatory support
- Author
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L. Lagazzi, Indrani Halder, Karen Hanley-Yanez, Charles F. McTiernan, Timothy N. Bachman, Aditi Nayak, C. Neill, Dennis M. McNamara, Ana Inashvili, Jeffrey J. Teuteberg, Marc A. Simon, Robert L. Kormos, and J. Larsen
- Subjects
Male ,0301 basic medicine ,Chemokine ,Time Factors ,Ventricular Dysfunction, Right ,CCR3 ,CCR4 ,C-C chemokine receptor type 7 ,C-C chemokine receptor type 6 ,Cardiorespiratory Medicine and Haematology ,030204 cardiovascular system & hematology ,CCR8 ,Cardiovascular ,Chemokine receptor ,0302 clinical medicine ,Risk Factors ,Receptors ,Ventricular Dysfunction ,biology ,chemokine receptor ,Middle Aged ,Survival Rate ,Right ,Heart Disease ,Receptors, Chemokine ,Female ,Cardiology and Cardiovascular Medicine ,Pulmonary and Respiratory Medicine ,Risk Assessment ,survival ,Article ,03 medical and health sciences ,Clinical Research ,left ventricular assist device ,medicine ,Humans ,Retrospective Studies ,Heart Failure ,Transplantation ,business.industry ,right ventricular failure ,Pennsylvania ,medicine.disease ,030104 developmental biology ,inflammation ,Heart failure ,Immunology ,biology.protein ,Surgery ,Heart-Assist Devices ,prognostication ,business ,Biomarkers ,Follow-Up Studies - Abstract
Background Right ventricular failure (RVF) complicates 9% to 44% of left ventricular assist device (LVAD) implants post-operatively. Current prediction scores perform only modestly in validation studies, and do not include immune markers. Chemokines are inflammatory signaling molecules with a fundamental role in cardiac physiology and stress adaptation. In this study we investigated chemokine receptor regulation in LVAD recipients who develop RVF. Methods Expression of chemokine receptor (CCR) genes 3 to 8 were examined in the peripheral blood of 111 LVAD patients, collected 24 hours before implant. RNA was isolated using a PAXgene protocol. Gene expression was assessed using a targeted microarray (RT2 Profiler PCR Array; Qiagen). Results were expressed as polymerase chain reaction (PCR) cycles to threshold and normalized to the average of 3 control genes, glyceraldehyde phosphate dehydrogenase (GAPDH), hypoxanthine phosphoribosyltransferase 1 (HPRT1) and β 2 -microglobulin (B2M). Secondary outcomes studied were 1-year mortality and long-term RV failure (RVF-LT). Results CCR3, CCR4, CCR6, CCR7 and CCR8 were downregulated in LVAD recipients with RVF. Within this cohort of patients, CCR4, CCR7 and CCR8 were further downregulated in those who required RV mechanical support. In addition, under-expression of CCR3 to CCR8 was independently associated with an increased risk of mortality at 1 year, even after adjusting for RVF. CCR expression did not predict RVF-LT in our patient cohort. Conclusions Pre-LVAD CCR downregulation is associated with RVF and increased mortality after implant. Inflammatory signatures may play a major role in prognostication in this patient population.
- Published
- 2017
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