LEVELS OF CIRCULATING ADHESION MOLECULES IN CONGESTIVE-HEART-FAILURE AND AFTER HEART-TRANSPLANTATION

Recent reports suggest a role for immunologic and inflammatory process es in the pathogenesis of congestive heart failure (CHF) and accelerat ed coronary artery disease (CAD) after heart transplantation (HT), The interaction between endothelial cells, leukocytes, and platelets invo lving various adhesion molecules may be of particular importance, We t herefore measured serum levels of soluble(s) vascular cell adhesion mo lecule-1 (VCAM-1), sP-selectin, and sE-selectin in 34 patients with se vere CHF (23 with CAD and 11 with idiopathic dilated cardiomyopathy) a nd in 20 healthy controls, Twenty of the patients were followed with s erial measurements of these circulating adhesion molecules (CAMs) for up to 2 years after HT, Levels of all 3 CAMs were significantly elevat ed in patients with CHF compared with controls irrespective of the eti ology of heart failure, with particularly high concentrations of sVCAM -1, After HT, different patterns in CAMs were found over time, Whereas there was a normalization of sE-selectin levels after HT, concentrati ons of sVCAM-1 also declined, but without normalization, In contrast, sP-selectin levels were persistently elevated, with the highest concen trations at the end of the study period, The persistent elevation of s P-selectin and the lack of normalization of sVCAM-1 levels were associ ated with persistently raised serum levels of tumor necrosis factor-al pha, and these findings were not related to either acute episodes of a llograft rejection or intercurrent infections, These results support t he notion that immunologic and inflammatory processes are important fe atures of CHF. Furthermore, the persistently elevated levels of CAMs a nd tumor necrosis factor-alpha found up to 2 years after HT may reflec t a state of persistent immune activation in these patients, possibly involved in the development of CAD after HT. (C) 1998 by Excerpta Medi co, Inc.