Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure
Background. The use of left ventricular assist device (LVAD) has increased considerably over the past decade; however, there is limited literature to assist in patient selection and monitoring. The frequency of adverse events remains high. We examined the early expression of circulating soluble ST2...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Journal of Immunology Research |
| Online Access: | http://dx.doi.org/10.1155/2020/5826176 |
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| author | Philipp Opfermann Elisabeth Simader Alessia Felli Michele Bevilacqua Caroline Holaubek Martin Dworschak Mohamed Mouhieddine Daniel Zimpfer Jan Hendrik Ankersmit Barbara Steinlechner |
| author_facet | Philipp Opfermann Elisabeth Simader Alessia Felli Michele Bevilacqua Caroline Holaubek Martin Dworschak Mohamed Mouhieddine Daniel Zimpfer Jan Hendrik Ankersmit Barbara Steinlechner |
| author_sort | Philipp Opfermann |
| collection | DOAJ |
| description | Background. The use of left ventricular assist device (LVAD) has increased considerably over the past decade; however, there is limited literature to assist in patient selection and monitoring. The frequency of adverse events remains high. We examined the early expression of circulating soluble ST2 (sST2), a biomarker with immunosuppressive and profibrotic activity, and assessed the risk of death at 1 year in patients receiving LVAD implant. Methods. We prospectively enrolled 20 heart failure patients and measured sST2, IL-33, and IL-6 serum concentrations over three weeks after LVAD implantation. We compared the kinetics of IL-6, sST2, and IL-33 release in survivors with those of nonsurvivors using mixed model two-way analysis of variance for repeated measures. We also collected data on hemodynamic parameters (i.e., cardiac output) and frequency of infections during the hospital stay. Results. LVAD therapy led to an immediate and significant improvement of the hemodynamic parameters in 1-year survivors and nonsurvivors alike. The 1-year survival rate was 65%. IL-6 concentrations showed a significant (p=0.03) peak at admission to the intensive care unit following LVAD implantation, whereas sST2 levels were massively increased (p<0.0003) on day 1. While 1-year survivors had persistently lower sST2 values compared to nonsurvivors during the first 3 weeks after LVAD implantation (p=0.012), no differences were observed in the temporal pattern of IL-6 or IL-33. The odds of detecting Candida species in the bronchoalveolar lavage fluid were 14 times higher in nonsurvivors than in survivors (OR 13.7, CI 1.4-127, p=0.02). Conclusion. In patients implanted with LVAD, circulating sST2 levels and frequency of Candida colonisation were associated with higher mortality. Awareness of this early immune response can guide physicians in risk-benefit analysis. |
| format | Article |
| id | doaj-art-7f238feb998048408b456c197fcb1eb4 |
| institution | Kabale University |
| issn | 2314-8861 2314-7156 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Immunology Research |
| spelling | doaj-art-7f238feb998048408b456c197fcb1eb42025-02-03T01:28:30ZengWileyJournal of Immunology Research2314-88612314-71562020-01-01202010.1155/2020/58261765826176Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart FailurePhilipp Opfermann0Elisabeth Simader1Alessia Felli2Michele Bevilacqua3Caroline Holaubek4Martin Dworschak5Mohamed Mouhieddine6Daniel Zimpfer7Jan Hendrik Ankersmit8Barbara Steinlechner9Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaDepartment of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaDepartment of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, AustriaDepartment of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, AustriaBackground. The use of left ventricular assist device (LVAD) has increased considerably over the past decade; however, there is limited literature to assist in patient selection and monitoring. The frequency of adverse events remains high. We examined the early expression of circulating soluble ST2 (sST2), a biomarker with immunosuppressive and profibrotic activity, and assessed the risk of death at 1 year in patients receiving LVAD implant. Methods. We prospectively enrolled 20 heart failure patients and measured sST2, IL-33, and IL-6 serum concentrations over three weeks after LVAD implantation. We compared the kinetics of IL-6, sST2, and IL-33 release in survivors with those of nonsurvivors using mixed model two-way analysis of variance for repeated measures. We also collected data on hemodynamic parameters (i.e., cardiac output) and frequency of infections during the hospital stay. Results. LVAD therapy led to an immediate and significant improvement of the hemodynamic parameters in 1-year survivors and nonsurvivors alike. The 1-year survival rate was 65%. IL-6 concentrations showed a significant (p=0.03) peak at admission to the intensive care unit following LVAD implantation, whereas sST2 levels were massively increased (p<0.0003) on day 1. While 1-year survivors had persistently lower sST2 values compared to nonsurvivors during the first 3 weeks after LVAD implantation (p=0.012), no differences were observed in the temporal pattern of IL-6 or IL-33. The odds of detecting Candida species in the bronchoalveolar lavage fluid were 14 times higher in nonsurvivors than in survivors (OR 13.7, CI 1.4-127, p=0.02). Conclusion. In patients implanted with LVAD, circulating sST2 levels and frequency of Candida colonisation were associated with higher mortality. Awareness of this early immune response can guide physicians in risk-benefit analysis.http://dx.doi.org/10.1155/2020/5826176 |
| spellingShingle | Philipp Opfermann Elisabeth Simader Alessia Felli Michele Bevilacqua Caroline Holaubek Martin Dworschak Mohamed Mouhieddine Daniel Zimpfer Jan Hendrik Ankersmit Barbara Steinlechner Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure Journal of Immunology Research |
| title | Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure |
| title_full | Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure |
| title_fullStr | Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure |
| title_full_unstemmed | Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure |
| title_short | Early sST2 Liberation after Implantation of a Left Ventricular Assist Device in Patients with Advanced Heart Failure |
| title_sort | early sst2 liberation after implantation of a left ventricular assist device in patients with advanced heart failure |
| url | http://dx.doi.org/10.1155/2020/5826176 |
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