Monday 23 June 2003 121 The circulating levels of TNF-α and IL-6 was signiﬁcantly higher in group of the patients with diastolic HF in comparison with control (347.1±65.5 and 15.8±1.9 pg/ml vs. 100.8±51.9 and 7±1.4 pg/ml accordingly, p<0.05). The TNF-α and IL-6 levels was signiﬁcantly lower in control group than in groups with impaired left ventricular relaxation (219.6±39.7 pg/ml and 14.5±2.2 pg/ml accordingly) and restriction/“pseudo-normalization” (772.3±161.5 and 20±3.2 pg/ml ac- cordingly) (p< 0.05). The TNF-α level was signiﬁcantly higher in the group of restriction/“pseudo-normalization” than in the group with im- paired relaxation. There was not signiﬁcant difference in the IL-6 level between these groups. The TNF-α level was signiﬁcantly higher in group of patients with NYHA class III-IV (519.8±114.6 pg/ml) in comparison with group with NYHA class II (199.1±46.6 pg/ml) (p<0.05). There was not signiﬁcant difference in the IL-6 level between these groups (18.3±3.1 pg/ml vs. 13.6±2.1 pg/ml). Conclusions: At diastolic HF arisen owing to hypertension and/or of the chronic forms of coronary disease, the levels of TNF-α and IL-6 are increased. The TNF-α level is positively correlated to the functional status by criteria NYHA, and also depends on a type of LV diastolic dysfunction, prevailing at the patients with restrictive “pseudo-normal” types of LV diastolic dysfunction. 562 Effect of cardiac resynchronization therapy on neurohormonal activation in patients with congestive heart failure G. Boerrigter 1 , S.C. Madden Vadnais 2 , L.C. Costello-Boerrigter 1 , A. Cataliotti 1 , D.M. Heublein 1 , M.R.S. Hill 2 , J.C. Burnett Jr 1 1 Mayo Clinic and Foundation, Cardiorenal Research Laboratory, Rochester, United States of America; 2 Medtronic Inc, Minneapolis, MN, United States of America Background: In patients with overt heart failure and ventricular dyssyn- chrony, cardiac resynchronization (CR) by biventricular pacing as eval- uated in the Multicenter InSync Randomized Clinical Evaluation (MIR- ACLE) trial has been shown to result in improvements in clinical status and left ventricular function. We evaluated the effect of CR on neurohor- monal (NH) activation, recognizing that NH mechanisms may serve as prognostic indicators of patient status and/or ventricular remodeling. We hypothesized that CR would result in a decrease in NH activation. Methods: Plasma NH measurements were perfomed at baseline prior to implantation of an atrial synchronous biventricular pacing device. Patients were randomized to control (C; pacing OFF, n=225) or treat- ment (P; pacing ON, n=228) groups. NHs were repeated at 3 and 6 months. Tests included B-type natriuretic peptide (BNP), cyclic guano- sine monophosphate (cGMP), plasma renin activity, aldosterone, nore- pinephrine, epinephrine, dopamine, big endothelin (BigET), and tumor necrosis factor alpha. Atrial natriuretic peptide (ANP) levels were avail- able for baseline and 3 months. Differences between groups were ana- lyzed by Mann-Whitney-U; changes within groups by Wilcoxon’s rank sum test. A p<0.05 was considered signiﬁcant. Results: There were no signiﬁcant differences in NHs between groups at baseline. Changes in NHs at 3 months were not signiﬁcant between groups. However, there was a trend for lower ANP values in P (p=0.055). Changes in NHs at 6 months between groups were signiﬁcant for cGMP only (p=0.02). Signiﬁcant within-group changes at 3 months showed de- creased BNP in P (p=0.019) and increased BigET in C (p<0.01) and P (p=0.04). Signiﬁcant within-group changes at 6 months showed de- creased BNP in C (p<0.01) and P (p<0.01), decreased cGMP in P (p=0.02), and increased BigET in C (p<0.01) and P (p<0.01). Conclusion: Compared to the control group, patients with cardiac resyn- chronization therapy had signiﬁcantly reduced cGMP values at 6 months and a trend for reduced ANP values at 3 months, suggesting a decreased activation of the natriuretic peptide receptor-A. In contrast, there were no signiﬁcant differences in BNP and other NHs between groups, implying that these NHs are not affected by cardiac resynchronization therapy. A potential prognostic signiﬁcance of these ﬁndings remains to be eluci- dated. 563 Interleukin-6 and tumor necrosis factor alpha in relation to myocardial infarct size and collagen formation M. Puhakka 1 , J. Magga 1 , S. Hietakorpi 1 , I. Penttilä 2 , P. Uusimaa 3 , J. Risteli 4 , K. Peuhkurinen 1 1 Kuopio University Hospital, Internal Medicine, Kuopio, Finland; 2 Kuopio University Hospital, Clinical Chemistry, Kuopio, Finland; 3 Oulu University Hospital, Internal Medicine, Oulu, Finland; 4 Oulu University Hospital, Clinical Chemistry, Oulu, Finland Background: Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF- alpha) are proinﬂammatory cytokines produced during infection, trauma and other stress. IL-6 and TNF-alpha levels increase after acute myocar- dial infarction (AMI) in humans. Experimental data suggest that these cytokines regulate the initiation of scar formation after AMI. We investi- gated the interrelationships of IL-6 and TNF-alpha, tissue injury, infarct size, cardiac function and collagen formation in humans. Methods: Serum and plasma samples were taken on 93 patients receiving thrombolytic treatment for their ﬁrst AMI. Collagen formation was eval- uated by measuring concentrations of serum aminoterminal propeptide of type III procollagen (PIIINP). Results: IL-6 levels increased by 44% (p < 0.001) and peaked at 24 h. Peak IL-6 levels correlated positively with area under the curve of creatine kinase MB mass (AUC of CK-MBm)(r = 0.31, p < 0.01), peak troponin T level (r = 0.34, p < 0.005), and PIIINP measured at discharge (r = 0.46, p < 0.001). There were no changes in TNF-alpha levels, and patients with left ventricular dysfunction (EF < 40%) had similar TNF- alpha levels as those with preserved left ventricular function. Ten patients used angiotensin converting enzyme (ACE) inhibitors before AMI. Nine used 16.7 ± 5.0 mg of enalapril daily and one used quinapril. The infarcts of these patients were of equal size as of those without ACE inhibitors (AUC of CK-MBm, 3.5 mgh/L, 0.7 - 10.1 vs 4.5 mgh/L, 0.1 - 21.9, p = ns.). In spite of that, IL-6 and CRP levels were signiﬁcantly higher (p < 0.05, analysis of variance for repeated measurements) in patients with ACE-inhibitors Conclusions: IL-6 may regulate collagen formation and thus remodel- ing of the left ventricle after AMI. Production of IL-6 after AMI may be regulated by angiotensin II, and levels of IL-6 can be modiﬁed by ACE inhibitors. In addition, TNF-alpha measurement is useless in the as- sessment of infarct size or left ventricular function during the immediate post-infarction period. 564 NT BNP versus BNP for the diagnosis of heart failure in patients over 75 years old R. El Mahmoud 1 , Y. Alibay 2 , D. Brun-Ney 3 , J.C. Boulard 3 , H. Puy 2 , G. Jondeau 1 1 Ambroise Pare, Cardiology, Boulogne, France; 2 Ambroise Pare, Biochemistery, Boulogne, France; 3 Ambroise Pare, Emergency, Boulogne, France Objectives: Compare value of plasma BNP and NT-proBNP for the di- agnosis of congestive heart failure (CHF) in patients over 75 years old coming for acute dyspnea in the emergency. Backgrounds: BNP value is established for the diagnosis of dyspnea in the emergency room in standard population. However, data in elderly patients are scarce and relative diagnostic value of NT-proBNP and BNP have not been reported in this population where renal failure is more prevalent. Methods: 103 consecutive patients over 75 y.o. who came to the emergency department for acute dyspnea were included. Plasma BNP (Biosite  ) and NT-proBNP (Roche diagnostic  ) were measured at ad- mission along with other standard biological parameters, and clinical variables were noted. Reference diagnosis was adjudicated by 2 indepen- dant cardiologists using all available information at discharge. Results: 61 were female, 42 were male, mean age was 84.9±6.2 years. Final diagnosis was CHF in 46 patients (45%), pulmonary embolism at Peking University on July 27, 2011 eurjhfsupp.oxfordjournals.org Downloaded from