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Cardiology Branch National Heart, Lung, and Blood
Institute,
Bethesda, Md
To the Editor:
Recently, Ommen et al1 published in
Circulation a very important observation: that relative
lymphocyte concentration could be a prognostic marker in patients with
symptomatic heart failure. I would like to add something
about the importance of the cellular immune system in
cardiovascular disease. I have shown that in acute
myocardial infarction (AMI), a low CD4/CD8 ratio and low CD4 cell count
on the first day of AMI strongly correlated with low ejection fraction
and high myocardial mass destruction, as reflected by high creatine
kinase levels.2 Patients with the lowest
CD4 counts on admission and those whose CD4 counts did not rise had a
reinfarction or death.2 Another
study3 demonstrated that patients with AMI had
significantly diminished delayed-type hypersensitivity and reduced
numbers of T lymphocytes.
One possible explanation for the "lymphopenia" phenomenon is the
increase in cortisol during a stress response, which causes a decrease
in the relative concentration of lymphocytes.1
Another possible explanation is that T lymphocytes modulate smooth
muscle proliferation during vascular repair. Rats that lacked T
lymphocytes had larger myocardial lesions than normal
rats.4 It is assumed that T lymphocytes produce
interferon-
References
1.
Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CGA, Thomson
SP, Gibbons RJ. Predictive power of the relative lymphocyte
concentration in patients with advanced heart failure.
Circulation. 1998;97:19–22.
2.
Blum A, Sclarovsky S, Rehavia E, Shohat B. Levels of
T-lymphocyte subpopulations, interleukin-1 beta, and soluble
interleukin-2 receptor in acute myocardial infarction. Am
Heart J. 1994;127:1226–1230.[Medline]
[Order article via Infotrieve]
3.
Kaufman HS, Kvitash VI. Immunologic abnormalities
associated with acute ischemic heart disease. Ann
Allergy. 1989;63:287–290.[Medline]
[Order article via Infotrieve]
4.
Hansson GK, Holm J, Holm S, Fotev Z, Hedrich HJ,
Fingerle J. T-lymphocytes inhibit the vascular response to injury.
Proc Natl Acad Sci USA. 1991;88:10530–10534.
5.
Hansson GK, Holm J. Interferon-
Mayo Clinic,
Rochester, Minn
We appreciate Dr Blum's interest in our article. He raises the
intriguing hypothesis that the relative lymphocytopenia observed in
acute myocardial infarction (AMI) and in chronic congestive heart
failure (CHF) may be a cause rather than an effect.
We have documented decreases in the total and relative number of
circulating lymphocytes during AMI1 and advanced
CHF.2 However, the kinetics of these changes may
be different. In AMI, most patients have a rise in
endogenous cortisol with associated lymphocytopenia and
granulocytosis.3 4 In our experience, these
changes in the peripheral blood rapidly returned to normal
if the patient had an uncomplicated AMI (unpublished observations). In
contrast, only a minority of patients with CHF have lymphocytopenia. We
do not have any information about its duration.
Additional studies are necessary to determine if the relative
lymphocytopenia is an effect of the stress response, as we have
suggested, or a cause of myocardial dysfunction, as Dr Blum
suggests.
References
1.
Thomson SP, Gibbons RJ, Smars PA, Suman VJ, Pierre RV,
Santrach PJ, Jiang N. Incremental value of the leukocyte differential
and the rapid creatine kinase-MB isoenzyme for the early diagnosis of
myocardial infarction. Ann Intern Med. 1995;122:335–341.
2.
Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CGA,
Thomson SP, Gibbons RJ. The predictive power of the relative lymphocyte
count in patients with advanced heart failure.
Circulation. 1998;97:19–22.
3.
Logan RW, Murdoch WR. Blood levels of hydrocortisone,
transaminases, and cholesterol after myocardial infarction.
Lancet. 1966;2:521–524.[Medline]
[Order article via Infotrieve]
4.
Bain RJ, Fox JP, Jagger J, Davies MK, Littler WA,
Murray RG. Serum cortisol levels predict infarct size and patient
mortality. Int J Cardiol. 1992;37:145–150.[Medline]
[Order article via Infotrieve]
© 1998 American Heart Association, Inc.
Correspondence
Role of Lymphocytes in Heart Disease
, which inhibits smooth muscle cell
proliferation.5 Thus, it might be that the
relative depletion in T lymphocytes is not just a marker but also a
causative factor in the deterioration of myocardial function in AMI and
heart failure. inhibits
arterial stenosis after injury.
Circulation. 1991;84:1266–1272.
Response
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