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Heart Failure Reviews

, Volume 18, Issue 6, pp 835–845 | Cite as

The immunological axis in heart failure: importance of the leukocyte differential

  • Muthiah Vaduganathan
  • Stephen J. Greene
  • Javed Butler
  • Hani N. Sabbah
  • Eduard Shantsila
  • Gregory Y. H. Lip
  • Mihai Gheorghiade
Article

Abstract

The important role of the immune system and inflammation in the pathophysiology of heart failure (HF) is becoming increasingly appreciated. We have reviewed the prognostic significance of under-recognized aspects of the leukocyte differential in HF, including lymphocytes, monocytes, eosinophils and mast cells. Studies to date evaluating lymphocyte counts in both chronic and hospitalized HF patients have consistently shown worse prognosis associated with low lymphocyte counts, despite widely heterogeneous study designs. Limited data suggest elevations in monocyte-derived cytokines and serum monocyte count may be predictive of poor outcomes in HF. Further data are required to better define the relationship between eosinophils, mast cells and HF. Leukocyte differentials are widely available, simple, inexpensive and appear to have independent prognostic significance, beyond traditional risk factors. Enhanced sympathetic activation and increased circulating cytokine levels (particularly tumor necrosis factor) have been implicated in the variability of leukocyte subpopulations. To date, immune-modulators targeting these mediators have been largely unsuccessful in improving cardiovascular outcomes in HF. Given the potential role of the immunological axis in HF, there may be an unmet need for novel therapeutic agents that can safely and effectively ameliorate these leukocyte derangements and perhaps improve the unacceptably high event rate in this population. Variations in leukocyte differentials may identify a high-risk subset of patients that may benefit from tailored immune therapies.

Keywords

Heart failure Immune activation Inflammation Prognosis Outcomes 

Notes

Acknowledgments

None.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Muthiah Vaduganathan
    • 1
  • Stephen J. Greene
    • 2
  • Javed Butler
    • 3
  • Hani N. Sabbah
    • 4
  • Eduard Shantsila
    • 5
  • Gregory Y. H. Lip
    • 5
  • Mihai Gheorghiade
    • 2
  1. 1.Department of MedicineMassachusetts General HospitalBostonUSA
  2. 2.Center for Cardiovascular InnovationNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Division of CardiologyEmory University School of MedicineAtlantaUSA
  4. 4.Department of MedicineHenry Ford HospitalDetroitUSA
  5. 5.Centre for Cardiovascular Sciences, City HospitalUniversity of BirminghamBirminghamUK

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