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Autoantibodies against β1‐Adrenergic Receptors: Response to Cardiac Resynchronization Therapy and Renal Function
Author(s) -
MICHELUCCI ANTONIO,
D'ELIOS MARIO MILCO,
STICCHI ELENA,
PIERAGNOLI PAOLO,
RICCIARDI GIUSEPPE,
FATINI CINZIA,
BENAGIANO MARISA,
NICCOLAI ELENA,
GRASSI ALESSIA,
ATTANÀ PAOLA,
NESTI MARTINA,
GRIFONI GINO,
PADELETTI LUIGI,
ABBATE ROSANNA,
PRISCO DOMENICO
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12757
Subject(s) - medicine , ejection fraction , renal function , cardiology , cystatin c , heart failure , odds ratio , creatinine , cardiac resynchronization therapy , blood urea nitrogen , sinus rhythm , confidence interval , atrial fibrillation
Background Cardiac resynchronization therapy (CRT) nonresponse remains a major clinical problem. Autoantibodies specific for the β1‐adrenergic (β1‐AAbs) and muscarinic (M2‐AAbs) receptors are found in patients with chronic heart failure (HF) of various etiologies. Materials and Methods We retrospectively analyzed 73 HF patients (median age 67 years, 84% males, New York Heart Association II–IV, in sinus rhythm, left ventricular ejection fraction <35%) who received CRT defibrillator (CRT‐D) from 2010 to 2013. β1‐AAbs and M2‐AAbs were measured by enzyme‐linked immunosorbent assay. Echocardiography was used to assess CRT response (reduction >15% in left ventricular end‐systolic volume at 6 months follow‐up). Renal function (RF) parameters (creatinine [Cr], blood urea nitrogen [BUN], estimated glomerular filtration rate [eGFR Modified Diet in Renal Disease], cystatin C [Cys‐C], and neutrophil gelatinase‐associated lipocalin [NGAL]) were also evaluated. Results A significantly higher percentage of patients positive for β1‐AAbs (OD sample/OD reference ratio >2.1) in nonresponders than in responder patients was observed (57% vs 27%, P = 0.004). No influence of M2‐AAbs on CRT‐D response was demonstrated. β1‐AAbs were predictive of a poor CRT‐D response (odds ratio [OR] [95% confidence interval (CI)] 3.64 [1.49–8.88], P = 0.005), also after adjustment for RF parameters (OR [95% CI] 4.95 [1.51–16.26], P = 0.008) observed to influence CRT‐D response (Cr P = 0.03, BUN P = 0.009, Cys‐C P = 0.02). The positive rates of β1‐AABs in patients with abnormal blood level of Cr, eGFR, Cys‐C, and NGAL were significantly higher than those with normal levels (P = 0.03, P = 0.02, P = 0.001, P = 0.007, respectively). Conclusions Our study suggests that (1) the evaluation of β1‐AAb is useful to identify responders to CRT‐D; (2) the presence of β1‐AAbs is in relationship with elevated renal function parameters.