Systemic Inflammatory Response Syndrome in End-Stage Heart Failure Patients Following Continuous-Flow Left Ventricular Assist Device Implantation: Differences in Plasma Redox Status and Leukocyte Activation

Abstract

The role of oxidative stress and leukocyte activation has not been elucidated in developing systemic inflammatory response syndrome (SIRS) in heart failure (HF) patients after continuous-flow left ventricular assist device (CF-LVAD) implantation. The objective of this study was to investigate the change of plasma redox status and leukocyte activation in CF-LVAD implanted HF patients with or without SIRS. We recruited 31 CF-LVAD implanted HF patients (16 SIRS and 15 non-SIRS) and 11 healthy volunteers as the control. Pre- and postimplant blood samples were collected from the HF patients. Plasma levels of oxidized low-density lipoprotein (oxLDL), malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD) in erythrocyte, myeloperoxidase (MPO), and polymorphonuclear elastase (PMN-elastase) were measured. The HF patients had a preexisting condition of oxidative stress than healthy controls as evident from the higher oxLDL and MDA levels as well as depleted SOD and TAC. Leukocyte activation in terms of higher plasma MPO and PMN-elastase was also prominent in HF patients than controls. Persistent oxidative stress and reduced antioxidant status were found to be more belligerent in HF patients with SIRS after the implantation of CF-LVAD when compared with non-SIRS patients. Similar to oxidative stress, the activation of blood leukocyte was significantly highlighted in SIRS patients after implantation compared with non-SIRS. We identified that the plasma redox status and leukocyte activation became more prominent in CF-LVAD implanted HF patients who developed SIRS. Our findings suggest that plasma biomarkers of oxidative stress and leukocyte activation may be associated with the development of SIRS after CF-LVAD implant surgery.

Keywords: Heart failure; Left ventricular assist device; Leukocyte activation; Oxidative stress; Systemic inflammatory response syndrome.

Figure 1

Change in plasma levels of oxidized low density lipoprotein (oxLDL) and lipid peroxidation product malondialdehyde (MDA) among non-SIRS and SIRS groups before and after CF-LVAD implantation. (A, C) Scatter plots representing the differences in oxLDL and MDA between the control and baseline HF patients. *p<0.05 is considered significant in Student's t-test. (B, D) Box-whisker plot shows differences in oxLDL and MDA before and after CF-LVAD implantation in non-SIRS and SIRS groups. The lines across each box plot represent the median value. The lines that extend from the top and the bottom of each box represent the lowest and highest observations still inside the lower and upper limit of confidence. *p<0.05 is considered significant in Mann–Whitney U-test.

Figure 2

Change in plasma levels of antioxidant enzyme superoxide dismutase (SOD) and total antioxidant capacity (TAC) among non-SIRS and SIRS groups before and after CF-LVAD implantation. (A, C) Scatter plots representing the differences in SOD and TAC between the control and baseline HF patients. *p<0.05 is considered significant in Student's t-test. (B, D) Box-whisker plot shows differences in SOD and TAC before and after CF-LVAD implantation in non-SIRS and SIRS groups. The lines across each box plot represent the median value. The lines that extend from the top and the bottom of each box represent the lowest and highest observations still inside the lower and upper limit of confidence. *p<0.05 is considered significant in Mann–Whitney U-test.

Figure 3

Change in plasma levels of myeloperoxidase (MPO) and polymorphonuclear elastase (PMNelastase) among non-SIRS and SIRS groups before and after CF-LVAD implantation. (A, C) Scatter plots representing the differences in MPO and PMN-elastase between the control and baseline HF patients. *p<0.05 is considered significant in Student's t-test. (B, D) Box-whisker plot shows differences in MPO and PMN-elastase before and after CF-LVAD implantation in non-SIRS and SIRS groups. The lines across each box plot represent the median value. The lines that extend from the top and the bottom of each box represent the lowest and highest observations still inside the lower and upper limit of confidence. *p<0.05 is considered significant in Mann–Whitney U-test.

Figure 4

Change in oxidative stress, antioxidant status and leukocyte activation due to major infection in SIRS patients (sepsis) after CF-LVAD implantation in compared to SIRS alone. The lines across each box plot represent the median value. The lines that extend from the top and the bottom of each box represent the lowest and highest observations still inside the lower and upper limit of confidence. *p<0.05 is considered significant in Mann–Whitney U-test.