Oxidative stress and inflammatory activation in end-stage heart failure do not ameliorate during early phase (1 month) of left ventricular mechanical assistance

Purpose: This study investigates the impact of early left ventricular (LV)-mechanical unloading on systemic oxidative stress and inflammation in end-stage heart failure (ESHF) patients. Methods: Circulating levels of oxidative stress marker 8-epi-PGF2a and of inflammatory mediators [interleukin (IL)-8 and neopterin, monocyte activation index] were analyzed in 22 stable ESHF-patients (13/9 in NYHA III/IV classes) and 18 LV assist device (LVAD)-recipients at pre-implant, and at 1 week and 1 month post-LVAD (PL). Multiorgan function was evaluated in both groups and following LVAD implantation by total sequential organ failure assessment (tSOFA)-score. Results: In LVAD-recipients the levels of oxidative-inflammatory markers and t-SOFA score were higher compared to stable ESHF-patients. After LVAD implantation the levels of IL-8 increased during first week, while at 1 month returned to pre-implant values. Only neopterin levels progressively increased during LVAD support. The levels of 8-epi-PGF2a were unchanged following device implantation. The tSOFA-score worsened at 1 PL week with respect to pre-implant value [8 (4, 9) vs 5 (3, 7) respectively, P,.01], but ameliorated at 1 PL month [1 (0, 1), P,.01 ] parallel to the reduced need of inotropic support [8 (1, 11) and 0 (0, 0) inotropic equivalent at pre implant and at 1 PL month, respectively; P=.002]. The t-SOFA-score related only with IL-8 levels (R=.52, P,.001) and inotropic equivalent (R=.80, P,.001). Conclusions: Hemodynamic instability in end-stage heart failure is associated to worsening of systemic oxidative stress and inflammatory milieu that do not improve in the early phase of hemodynamic recovery by LVAD. During mechanical support changes in organ functions are associated to IL-8 level flotation and changes in inotropic need, as reflecting hemodynamic recovery. The oxidative stress and inflammatory milieu during mechanical support should now be investigated in the late phase in order to find a correlation with long-term outcome.