Usefulness of cell-mediated immune function in risk stratification for patients with advanced heart failure

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• 作者：Vijaiganesh Nagarajan ; MD ; MRCP^a ; Adrian V. Hernandez ; MD ; PhD^b ; ^c ; Clay A. Cauthen ; MD ; MPH^d ; Randall C. Starling ; MD ; MPH^e ; W. H. Wilson Tang ; MD^e ; ^{tangw@ccf.org}
• 刊名：American Heart Journal
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：183
• 期：Complete
• 页码：35-39
• 全文大小：216 K
• 卷排序：183

文摘

Although heightened inflammation and autoimmune responses have been well described in patients with heart failure, the role of cell-mediated immune function in the pathogenesis and progression of heart failure is unclear. The aim of our study is to evaluate the prognostic role of cell-mediated immune function in patients with advanced heart failure.MethodsWe studied patients with advanced heart failure referred for evaluation of candidacy for advanced heart failure therapies between 2007 and 2010. Cell-mediated immune response was categorized into 3 groups—low or poor immune response (≤225 ng/mL), moderate or normal immune response (226-524 ng/mL), and strong immune response (≥525 ng/mL)—using a phytohemagglutinin-stimulated T-cell response assay.ResultsOut of 368 patients, 41 patients (11.1%) had poor immune function, 258 patients (70.1%) had normal immune function, and 69 patients (18.7%) had strong immune function. The primary outcome of all-cause mortality or cardiac transplantation occurred in 63.4%, 45.3%, and 34.8% in the poor immunity, normal immunity, and strong immune function groups, respectively. In univariate analysis, cell-mediated immune function was strongly associated with the primary outcome (P = .014). Poor immune function portended worse prognosis (hazard ratio = 2.18, 95% CI 1.01-4.70, P = .047), and strong immune function was associated with better survival (hazard ratio = 0.67, 95% CI 0.43-1.04). However, when adjusted for multiple variables in multivariate analysis, immune function status lost its overall significance to predict primary outcome (P = .11), but the direction to an increased risk of primary outcome was maintained in the poor immune function group.ConclusionsPoor cell-mediated immune function measured by a clinically available assay could be associated with more adverse long-term prognosis in patients with advanced heart failure.