Circulating heat shock proteins and inflammatory markers in patients with idiopathic left ventricle dysfunction: their relationships with myocardial and microvascular impairment.

Little information is available on peripheral levels of Hsp72, Hsp60, and anti-Hsp60 antibodies in patients
with left ventricular (LV) dysfunction due to non-atherosclerotic cardiac disease. In this study, serum Hsp72, Hsp60
and anti-Hsp60 antibodies, IL-6, and C-reactive protein (CRP) were measured in 44 healthy controls and in 82 patients
with angiographically normal coronary arteries (LV ejection fraction [EF] 50%, n 22; 35% to 50%, n 32;
35%, n 28). Patients with more severe disease (more depressed myocardial blood flow at rest and during dipyridamole,
indicative of coronary microvascular impairment) showed more elevated circulating Hsp60 and auto-antibodies,
Hsp72, and CRP levels. IL-6 was increased progressively as a function of severity of LV dysfunction. Anti-Hsp60
antibodies, Hsp72, and IL-6 were significantly correlated with brain natriuretic peptide (BNP) levels and LV end-diastolic
dimensions (LVEDD) values. IL-6 tended to be related with Hsp72 in particular in patients with more severe disease
(r 0.45, P 0.021). Hsp60 and Hsp72 activation and inflammatory markers were correlated with the extent of cardiac
and microvascular dysfunction in patients with angiographycally normal coronary arteries. These results suggest a
pathogenic role of infective-metabolic insult and inflammatory reaction in the development of vascular and myocardial
damage in patients with heart failure even in the absence of overt coronary artery disease.