Despite the wealth of information available on the role of inflammation in heart failure, relatively little has been published on the prognostic role of white blood cells or the leukocyte subsets in the setting of heart failure. For patients presenting with acute MI, elevated leukocyte count (121,122) or relative neutrophilia (>65%) on admission has been associated with subsequent development of heart failure (123). Similarly, peripheral monocytosis 24 h after the onset of MI has been associated with the development of LV dysfunction and LV aneurysm (124). However, the prognostic role of leukocytosis in heart failure independent of ischemic heart has not been well studied.
In a study of211 patients with heart failure referred for cardiac transplantation, Ommen et al. (125) found that survival was significantly lower for patients with a low-percentage lymphocyte count, defined as a lymphocyte count of <20.3%, compared with those with a normal-percentage lymphocyte count. NYHA class and percentage lymphocyte count were both independent predictors of survival. They hypothesized that the physiological
3 4 Follow-up (Years)
Fig. 6. Kaplan-Meier survival plot for 159 patients with chronic heart failure. Patients were sub-grouped according to ESR. The group of patients with high ESR (©15 mm/h) had an impaired survival compared with patients with an ESR <15 mm/h (RR: 2.62; 95% confidence interval: 1.58-4.36; p < 0.0001). (Reproduced from ref. 20 with permission of the American College of Cardiology and Elsevier Science Inc. ©2000.)
stress experienced by patients with heart failure may result in an increased production of Cortisol and a shift in the leukocyte differential toward a decreased percentage of lymphocytes. Similarly, in 861 elderly patients enrolled in the CHF Italian Study, Aconfora et al. (126) reported that 38% ofthe patients had a relative lymphocyte count of <20%. The 3-yr all-cause mortality in patients with heart failure and a low lymphocyte count was 64% compared with 40% in patients with a normal relative lymphocyte count (p < 0.0001). Together, the findings of these studies raise the possibility that a low relative lymphocyte count is an independent marker of poor prognosis in patients with heart failure.
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