P188	The use of plasma NT-pro BNP, Interleukin 6, TNFα and sCD 40L in assessment of acute heart failure severity in emergency department.
1R.Pudil, 2C.Andrys, 3M.Tichy, 1J.Vojacek
1Charles University Prague, Medical Faculty, Department of Medicine, Hradec Kralove, CZ; 2Department of Clinical Immunology and Allergology, University Hospital,, Hradec Kralove, CZ; 3Department of Clinican Biochemistry, University Hospital,, Hradec Kralove, CZ.

Financial support by the cardiovascular research project of the Charles University Prague MSM 0021620817 Background: Plasma natriuretic peptide levels and cytokine (interleukin 6, IL6, tumor necrosis factor alpha, TNFa) levels are increased in heart failure. Furthermore, plasma natriuretic peptide levels can correlate with the severity of acute HF. Soluble CD40 ligand (sCD40L) is a marker of immune system activation. However, little is known about cytokine and sCD40L levels their correlation with the heart failure severity. The aim of the study was to assess plasma IL 6, TNFa, sCD40L and N-terminal pro brain natriuretic peptide (NT-proBNP) levels and to analyse the clinical status, chest X-ray and echocardiographic parameters in acute heart failure. Methods: We analysed data from 96 consecutive patients (age 66,12±years) admitted to intensive care department with acute heart failure. All plasma samples were withdrawn at the time of admission. Plasma NT-proBNP level were assessed using quantitative electrochemiluminiscence method (Elecsys, Roche), plasma cytokine levels were assessed by the use of ELISA method (RD Quantikine). Ejection fraction was assessed using echocardiography. Results: Mean plasma NT-proBNP level in the group of all patients was increased (9136.72±9767.51 pg/mL vs. controls 91.27±76.63 pg/mL, p<0.001). Mean IL 6 level was 29.3±22.23 pg/mL, vs. 2.4±1.5 pg/mL, p<0.001, and mean TNFa level 2.9±3.69 plasma TNFa pg/mL, vs. 0.9±0.3 pg/mL, p<0.01. Mean plasma sCD40L levels were 1.67±1.62 pg/mL, vs. 0,63±0,38 pg/mL, p<0,01. 13 patients developed lung oedema and their plasma NT-proBNP was 16264.1±9352.42pg/mL, plasma IL-6 level 33.8±25. pg/mL, plasma TNFa 2,6±2,1 pg/mL and plasma sCD40L was 1,44±1,43 pg/mL. 6 pts died due to cardiogenic shock (mean plasma NT-proBNP was 27798.2±14838.11pg/mL, plasma IL 6 was 44.6±22.7 pg/mL, and sCD40L was 2.1±3.1 pg/mL). Conclusion: The study showed (1) increase in plasma NT-pro BNP, interleukin 6 and TNF alpha levels in acute heart failure. (2) The plasma soluble CD40L as a marker of inflammation was also increased despite the troponin T negativity. (3) Plasma NT-proBNP and interleukin 6 levels can reflect the heart failure severity.

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