ISCHEMIC VERSUS IDIOPATHIC CARDIOMYOPATHY - DIFFERING NEUROHUMORAL PROFILES DESPITE COMPARABLE PEAK OXYGEN-UPTAKE

Objective: We tested the hypothesis that neurohormonal and immunologic al activation differs in ischemic and idiopathic dilated cardiomyopath y since recent intervention trials indicate that ischemic cardiomyopat hy seems to carry a worse prognosis than idiopathic cardiomyopathy of comparable clinical severity. Methods: In ten patients with ischemic c ardiomyopathy undergoing spiroergometric evaluation venous levels of n orepinephrine, epinephrine, renin, angiotensin, atrial natriuretic pep tide as well as soluble interleukin-2-receptor were determined before, during and 10 min after exercise. Results were compared to sixteen pa tients with idiopathic cardiomyopathy with similar peak oxygen uptake (13.3+/-3 vs. 13.6+/-3 ml/kg/min; P=ns). Results: In ischemic patients , norepinephrine, angiotensin, and interleukin-2 receptor levels were significantly higher before, during and after exercise. Interleukin-2- receptor levels correlated with angiotensin. Conclusions: We conclude that in ischemic as compared to idiopathic cardiomyopathy, a more pron ounced activation of the sympathetic, renin-angiotensin and T-cell imm une system is present at rest, during and after exercise. These data m ay contribute to explain differences in response to intervention and i n prognosis. They warrant further investigation. (C) 1997 Elsevier Sci ence Ireland Ltd.