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Monocyte subset distribution predicts survival in patients with acute heart failure

Session Poster Session 1 - Acute Heart Failure, Cardiogenic Shock and Advanced Cardiac Support

Speaker Konstantin A Krychtiuk

Event : Acute Cardiovascular Care 2018

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Biomarkers
  • Session type : Poster Session

Authors : KA Krychtiuk (Vienna,AT), M Lenz (Vienna,AT), L Wutzlhofer (Vienna,AT), B Bauer (Vienna,AT), DF Draxler (Vienna,AT), K Huber (Vienna,AT), J Wojta (Vienna,AT), G Heinz (Vienna,AT), WS Speidl (Vienna,AT)

Authors:
KA Krychtiuk1 , M Lenz1 , L Wutzlhofer1 , B Bauer1 , DF Draxler1 , K Huber2 , J Wojta1 , G Heinz1 , WS Speidl1 , 1Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology - Vienna - Austria , 2Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine - Vienna - Austria ,

Citation:
European Heart Journal Supplement ( 2018 ) 7 ( Supplement ), S63

Background: Activation of the innate immune system contributes to the pathogenesis of acute heart failure (AHF). As key regulators of innate immunity, monocytes may play a crucial role in the development of this disease. Monocytes are a heterogenous cell population that can be divided into at least three cell populations: Classical monocytes (CM; CD14++CD16-), intermediate monocytes (IM; CD14++CD16+CCR2+) and non-classical monocytes (NCM; CD14+CD16++CCR2-).
Purpose: The aim of this study was to analyze whether monocyte subset distribution is associated with 30-day survival in patients with AHF.
Methods: We included 90 consecutive patients with AHF (33% with cardiogenic shock, 21% with acutely decompensated HF and 46% of patients suffered from AHF after cardiac arrest). Blood was taken at admission and after 72 hours and monocyte subset distribution was analyzed.
Results: Mean age was 62.1 ± 16.0, 76.7% of patients were male and median NT-proBNP levels were 4986 (1525 – 23842) pg/mL. 30-day survival was 64.4%. At admission, no association between monocyte subsets and outcome was seen. However on day 4, increased levels of IM (9.4 (4.0-13.8) % vs. 4.3 (2.1-7.9) %; p=0.02, respectively). and lower levels of CM were predictive of 30-day mortality (86.8 (77.5 – 88.9) % vs. 90.5 (84.3 – 92.9), p= 0.02, respectively), while the NCM proportion was not associated with mortality. Risk of dying was increased 10.6-fold in the lowest tertile of CM and 9.5-fold in patients in the lowest IM tertile (p < 0.05 for both).
Concusion: Circulating monocyte subsets are associated with 30-day mortality in patients with AHF requiring ICU admission. Activation status of the innate immune system as reflected by monocyte subset distribution may play a major role in pathophysiology and outcome in this patient cohort.

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