Beta-Blockade Does Not Alter Plasma Cytokine Concentrations and Ventricular Function in Young Adults With Right Ventricular Dysfunction Secondary to Operated Congenital Heart Disease

Abstract

Right heart failure is a major problem of young adults with congenital heart disease (ACHD) that has been corrected by cardiac surgery. In left ventricular dysfunction (LVD), beta-blocker therapy improved cytokine concentrations and clinical status. Thus, the effect of bisoprolol on clinical status and plasma cytokine concentrations in ACHD patients with right heart failure after surgical correction for Tetralogy of Fallot was investigated. A prospective, randomized, double-blind, placebo controlled study for a duration of 6 months was carried out. A total of 34 patients (30.9+/-9.5 years; New York Heart Association I or II) with brain natriuretic peptide plasma concentrations >100 pg/ml and peak oxygen uptake <25 ml . kg(-1) .min(-1) were recruited. Bisoprolol did not reduce plasma concentrations of soluble tumor necrosis factor receptors (sTNF-R) and interleukin-6 (IL-6) in ACHD patients (before/after: sTNF-R1: 750+/-131/802+/-130; sTNF-R2: 3,693+/-1,043/4,166+/-840; IL-6: 12.94+/-26.03/13.69+/-16.58 pg/ml). Likewise, peak oxygen uptake, right and left ventricular parameters (determined by magnetic resonance imaging) were not improved by bisoprolol treatment. In contrast to previously observed beneficial effect(s) of beta-blockade in patients with LVD, there were no beneficial therapeutic effects or cytokine reduction in asymptomatic or minimal symptomatic ACHD patients. These data point to a different pathophysiological role of cytokines in ACHD patients with right ventricular dysfunction, as compared to patients with LVD.