Regular paperElevated circulating levels of inflammatory cytokines and bacterial endotoxin in adults with congenital heart disease☆
Section snippets
Patient population
We performed a prospective cross-sectional study assessing immunologic parameters in 52 consecutive adults with congenital heart disease (age 34 ± 2 years, 28 women; New York Heart Association [NYHA] class 2.0 ± 0.1) and 18 healthy age-matched control subjects (age 31 ± 1 years, 9 women; Table 1). Control subjects were recruited from staff members and their relatives at the Royal Brompton Hospital, none of whom were taking any medication or had any preexisting medical disorder. Patients with a
Results
Clinical details of the patients and controls are listed in Table 1; results from the cytokine parameters and endotoxin levels are listed in Table 2. There was no significant difference in mean age or the ratio of men to women between patient and control groups (all p >0.3). Patients were noted to have a significantly lower weight (p <0.05), with a trend toward a lower percent ideal body weight (p = 0.07) compared with controls. Patients with moderate to severe symptoms had significantly lower
Discussion
This study shows that there is immune activation in adult patients with congenital heart disease compared with healthy controls. Furthermore, patients with the most advanced disease have the greatest degree of inflammatory cytokine activation and endotoxemia (FIGURE 1, FIGURE 2). Patients with edema, in particular, were noted to have a significant increase in endotoxin activity compared with the patients without edema (Figure 2). Although sTNFR concentrations were not significantly increased in
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Dr. Sharma was supported by the Robert Luff Foundation, London, United Kingdom. Dr. Bolger and the Department of Cardiac Medicine were supported by the British Heart Foundation, London, United Kingdom. Dr. Coats was supported by the Viscount Royston Trust Fund, London, United Kingdom.