Thromb Haemost 2017; 117(02): 349-356
DOI: 10.1160/TH16-07-0531
Blood Cells, Inflammation and Infection
Schattauer GmbH

The impact of CD4+CD28null T-lymphocytes on atrial fibrillation and mortality in patients with chronic heart failure

Patrick Sulzgruber
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Lorenz Koller
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Max-Paul Winter
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Bernhard Richter
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Steffen Blum
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Magdalena Korpak
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Martin Hülsmann
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Georg Goliasch
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Johann Wojta
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
,
Alexander Niessner
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
› Author Affiliations
Financial support: The study was supported and received funding for materials by the ‘Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology‘ (ATVB). (Vienna, Austria).
Further Information

Publication History

Received:14 July 2016

Accepted after major revision:03 November 2016

Publication Date:
13 November 2017 (online)

Summary

Atrial fibrillation (AF) represents the most common cardiac arrhythmia. Especially in patients with chronic heart failure (CHF) the development of AF represents a severe complication resulting in haemodynamic deterioration. While pro-inflammatory cytokines proved to have a pivotal role in the development and progression of both AF and CHF, less attention has been paid to the cellular immunity. Therefore we prospectively enrolled 112 patients with CHF and performed fluorescein-activated cell sorting (FACS). Patients were stratified in two subgroups according to patients presenting with AF (n=56) and patients free of AF (n=56). Comparing AF to non-AF patients we found a significantly lower fraction of regulatory T cells (p<0.001) in patients presenting with AF. However there was a higher fraction of CD4+ cells (p=0.007) and more specifically a significantly higher number of cytotoxic T cells characterised by the loss of CD28 within CD4 T cells (CD4+CD28null; p=0.035) in individuals with AF. After a mean follow-up time of 4.5 years 32 (28.6 %) patients died due to cardiovascular causes. CD4+CD28null cells were significantly associated with cardiovascular mortality in patients presenting with AF, with an adjusted HR per one standard deviation (1-SD) of 1.59 (95 % CI 1.13–2.24; p=0.008), but not in patients free of AF with an adjusted HR per 1-SD of 1.27 (95 % CI 0.86–1.87; p=0.216). We found that the fraction of CD4+CD28null cells proved to be predictive on outcome in CHF-patients presenting with AF. Our results might indicate a potential role of CD4+CD28null cells in the pathogenesis of AF which needs to be confirmed in future studies.

Supplementary Material to this article is available online at www.thrombosis-online.com.