High leptin and resistin expression in chronic heart failure: adverse outcome in patients with dilated and inflammatory cardiomyopathy

The expression of leptin and resistin is known to be positively correlated with the incidence of chronic heart failure (CHF). Both adipokines have been implicated in immunomodulation and cardiac remodelling. Therefore, we performed for the first time a clinical study to elucidate the effects of leptin and resistin on progression of CHF in patients with non-ischaemic dilated (DCM) and inflammatory (DCMi) cardiomyopathy. For the clinical study 120 patients were divided into a control (n 16), DCM (n 52), and DCMi (n 52) group to determine the effect of leptin and resistin on CHF progression. Nuclear factor-B (NF-B) activation, reactive oxygen species generation, and tumour necrosis factor- (TNF-) and interleukin-6 (IL-6) expression following adipokine exposition were determined in vitro in cardiomyocytes. Leptin and resistin systemic plasma levels and not cardiac expression were significantly elevated in patients with DCM (leptin, 13.12 17.2 ng/mL, P 0.05; resistin, 6.87 2.25 ng/mL, P 0.05) and DCMi (leptin, 13.63 16 ng/mL, P 0.05; resistin, 7.27 2.2 ng/mL, P 0.05) compared with the control group (leptin, 7.34 5.7 ng/mL; resistin, 4.4 1.18 ng/mL). A multivariate linear regression model revealed low leptin and resistin plasma levels as contributors for favourable cardiac functional parameters at 6-month follow-up independent of inflammatory conditions. Cell culture experiments in vitro showed leptin and resistin to be potent regulators of TNF- and IL-6 expression in cardiomyocytes, leading to significantly increased redox stress in cardiac cells. High leptin and resistin expression in patients with DCM and DCMi is associated with CHF progression, i.e. severe cardiac dysfunction, independent of immune responses.