Abstract
The aim of this research was to correlate indicators of proinflammatory status and the structural/functional characteristics of the cardiovascular system comparatively in male and female patients with essential hypertension (EH) complicated by diastolic chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF). The study included 104 middle-aged patients (55 males (M) and 49 females (F)) with first- or second-degree EH complicated by CHF with preserved LVEF. They all belonged to the low functional class of CHF, with LVEF ≥50%, first- or second-degree of LV diastolic dysfunction (LVDD), LV hypertrophy (LVH), and dilatation of the left atrium (LA) with a sinus rhythm and N-terminal brain natriuretic peptide >125 pg/mL. Serum levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6) were measured. To identify the relationship between the proinflammatory pattern and cardiovascular parameters, Spearman’s rank correlation coefficients were determined. M had markedly higher levels of CRP, TNF-α, and IL-6 compared to F. However, all the mean values corresponded to the reference range. Significant direct associations of CRP level with the LV mass index (LVMI), relative wall thickness (RWT), LA volume index (LAVI), E/e’ ratio, and systolic and diastolic blood pressure (SBP, DBP) existed in both M and F, as well as negative correlations of CRP with LVDD parameter e’ and distance covered in a 6 min walk test. M and F had a positive association between IL-6 and LVMI, LAVI, E/e’ ratio, SBP, RWT, and DBP, as well as strong negative associations between IL-6 and e’ and distance passed in 6 min in each group. Significant direct correlations existed between serum TNF-α level and LVMI, RWT, LAVI, E/e’, SBP, and DBP both in M and F. Furthermore, there were negative relationships of TNF-α level with e’ and the distance covered for the 6 min walk. This study demonstrated a close relationship between the blood levels of proinflammatory autacoids and indicators of EH, exercise tolerance, LVH, LVDD, and LA enlargement, regardless of the patient’s sex. Compared to female patients, male patients had stronger correlations of CRP, TNF-α, and IL-6 levels with indicators of LVDD degree.
Highlights
Essential hypertension (EH) plays a key role in the pathogenesis of chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF)
The prevalence of CHF with preserved LVEF has sex differences, the comparison of proinflammatory status in male and female cases of CHF with preserved LV contractility in homogeneous groups was never assessed, the immune systems of men and women have obvious differences impacting the pathophysiology of many immunopathological disorders [12]
We evaluated the gender peculiarities of immune inflammation laboratory markers in EH complicated by CHF with preserved LVEF
Summary
Essential hypertension (EH) plays a key role in the pathogenesis of chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF). This form of CHF makes up 30–55% of all cases of circulatory failure cases [1,2,3]. Patients with chronic heart failure with preserved LVEF usually have a set of concomitant diseases (obesity, type 2 diabetes mellitus, renal dysfunction, chronic obstructive pulmonary disease, and so on) This form of CHF affects predominantly female patients. The systemic equivalent of low-intensity inflammation partakes in the pathogenesis of many cardiovascular diseases and syndromes, including EH, metabolic syndrome, atherosclerosis, left ventricular hypertrophy (LVH), atrial fibrillation, and acute and chronic heart failure [6,7,8,9,10]. The prevalence of CHF with preserved LVEF has sex differences, the comparison of proinflammatory status in male and female cases of CHF with preserved LV contractility in homogeneous groups (age and body-mass-index-matched, with similar comorbidities and severity of the underlying diseases) was never assessed, the immune systems of men and women have obvious differences impacting the pathophysiology of many immunopathological disorders [12]
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