The Effect of Left Ventricular Filling Pressure on Pulmonary Clearance of Free Radical Loaded White Blood Cells and Platelets in Congestive Heart Failure Patients Before and After Biventricular Pacing

Study Overview
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Brief Summary
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To assess whether a correlation exist between the degree of pulmonary clearance of free radical positive white bloodcells and platelets and the degree of pulmonary congestion in congestive heart failure (CHF) patients To asses whether cardiac resynchronization therapy improves pulmonary clearance of free radical positive white blood cells and platelets in CHF patients by alleviating pulmonary congestion Interaction of oxidative stress with circulating endothelial progenitor cells (EPCs) and presence of apoptotic endothelial (progenitor) cells

Detailed Description
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Evidence exists that oxidative stress is enhanced in congestive heart failure patients resulting in damage to cellular lipids, proteins and DNA. Because of free radical-induced apoptosis of skeletal muscle fibers, oxidative stress is an important contributor to skeletal muscle fatigue and low exercise tolerance of congestive heart failure patients. Enhanced oxidative stress in congestive heart failure can exert negative inotropic effects and can have important effects on the structure and function of the myocardium, and may be implicated in the progression of congestive heart failure. Free radical stress could also impair recruitment and differentiation of circulating endothelial progenitor cells resulting in increased all cause mortality. Reduced pulmonary clearance of free radical loaded white blood cells and platelets is an important contributor to enhanced oxidative stress in congestive heart failure patients. Failure of pulmonary clearance of free radical loaded white blood cells and platelets probably results from pulmonary congestion which has led to the rationale of the current study. Biventricular pacing for resynchronization therapy in congestive heart failure patients reduces left ventricular filling pressure and pulmonary congestion. Biventricular pacing may therefore augment pulmonary clearance of free radical loaded white blood cells and platelets in congestive heart failure patients. We conduct a prospective, observational clinical study to investigate the correlation of left ventricular filling pressure, pulmonary clearance of FR loaded circulating white blood cells and platelets and number of endothelial progenitor cells in congestive heart failure (CHF) patients before and after implantation of a biventricular pacemaker for resynchronization therapy.

Official Title
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The Effect of Left Ventricular Filling Pressure on Pulmonary Clearance of Free Radical Loaded White Blood Cells and Platelets in Congestive Heart Failure Patients Before and After Biventricular Pacing

Conditions
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Congestive Heart Failure

Participation Criteria
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Eligibility Criteria
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Patient selection Informed consented participants are recruited among all patients admitted to the OLVG hospital. Inclusion criteria: Chronic congestive heart failure patients of all ages selected for biventricular pacemaker implantation for resynchronization therapy Dyspnoe NYHA class III and IV Optimal and constant heart failure treatment according to the ESC guidelines Exclusion criteria: Renal failure (creatinine > 1.70 mg/dl) Signs of infection or inflammation
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CHF<br>Informed consented participants are recruited among all patients admitted to the OLVG hospital. Inclusion criteria: Chronic congestive heart failure patients of all ages selected for biventricular pacemaker implantation for resynchronization therapy Dyspnoe NYHA class III and IV Optimal and constant heart failure treatment according to the ESC guidelines Exclusion criteria: Renal failure (creatinine >1.70 mg/dl) Signs of infection or inflammation | |
| Control<br>The control group consists of ten age-matched volunteers with a normal left ventricular ejection fraction and without signs or symptoms of heart failure. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| • Number of (apoptotic) endothelial (progenitor) cells |  | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| • Oxidative stress: cytosolic and mitochondrial FR |  | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Heart failure, Oxidative stress, Endothelial Progenitor Cells, White blood cells