2009 Southern Regional Meeting Abstracts

Purpose of Study: A reduction in relative (%L) lymphocyte count has been found in Caucasians with splanchnic congestion of diverse causality, including constrictive pericardial disease or marked tricuspid regurgitation, and which is reversible following surgical intervention. Whether a lymphocytopenia occurs in African-American (AA) patients with decompensated biventricular failure having splanchnic congestion (DecompHF) due to a dilated cardiomyopathy (DCM) is unclear. Whether it would be reversible once the splanchnic congestion had been resolved by medical management is also uncertain. Accordingly, we monitored %L in AA patients hospitalized because of decompensated biventricular failure due to a DCM of ischemic or nonischemic origin and having reduced ejection fraction (<35%). We repeated the assessment of %L weeks later and after signs and symptoms of splanchnic congestion had resolved.
Methods Used: Fifty-six AA patients (42 males; 51.8±1.7 yrs) hospitalized at the Regional Medical Center here in Memphis because of DecompHF and who on admission were found to have jugular venous distention, tricuspid regurgitation, hepatic and splanchnic congestion, and bilateral lower extremity edema, together with echocardiographic evidence of tricuspid regurgitation and dilated inferior vena cava without respiratory variation. Weeks later in the outpatient clinic, %L was again available in 31 of these patients (31 males; 51.8±2.6 yrs), who now were compensated without splanchnic congestion.
Summary of Results: In AA patients hospitalized with DecompHF, %L was reduced (14.44±0.95%) below the normal reference range (20-40%) on admission and this lymphocytopenia was present in both AA men and women and irrespective of the etiologic origin of their DCM. Follow-up %L had normalized (24.67±1.02%) when these patients no longer had splanchnic congestion.
Conclusions: A relative lymphocytopenia is found on admission in AA patients hospitalized with DecompHF and which is reversible weeks after splanchnic congestion has resolved with medical therapy. These findings call into question the role of a reversible enteric loss of lymphocytes and/or an altered behavior of the gut-associated lymphoid tissue, the body’s largest lymphoid organ.