Abstract 20065: Periodontitis and Bone Metabolism in Patients With Advanced Heart Failure and After Heart Transplantation

Background: Heart failure (HF) is a multi-organ, pro-inflammatory syndrome that impairs bone metabolism. Proinflammatory cytokines and bone catabolism enhance periodontal disease, a local inflammatory, bacteria-induced disease that causes bone loss and periodontal soft tissue destruction. Hypothesis: Patients with advanced HF before and after heart transplantation (HTx) have more severe periodontal disease as compared to age and smoking-matched controls. Further, local inflammatory markers in the saliva and gingival crevicular fluid (GCF) can be used as markers of the local inflammatory periodontal burden in patients with HF. Methods: Medical and dental examinations were performed on patients with HF (n=41), following heart transplantation (post-HTx, n=40) and controls (n=32). Blood, saliva and GCF samples were taken to investigate markers of bone metabolism and inflammation. Results: Average New York Heart Association classification for HF was class III. Average time since HTx was 33.14 months. Overall periodontal diagnosis was more severe in patients with advanced HF and post-HTx versus controls (p<0.0001). Pro-inflammatory tumor necrosis factor-alpha (TNF-α) was higher in HF and HTx patients as compared to controls (p<0.05). Both, HF and HTx participants had higher levels of bone resorption marker C-terminal telopeptide and parathyroid hormone with subjects in the HF group having the highest serum levels of all groups (p≤0.05). In contrast, 25-VitD was lowest in patients with HF. The bone formation markers osteocalcin and procollagen-1 N-terminal peptide did not display differences between groups. Further, we found a significant correlation between beta-glucoronidase in saliva (r=0.4863, p<0.01) and interleukin-1b in saliva (r=0.4999, p<0.01) and GCF (r=0.5943, p<0.001) and the severity of periodontal disease. Conclusion: Patients with advanced HF exhibit more severe periodontal disease associated with increased bone turnover markers when compared to control patients. Further, periodontal disease severity was detectable in saliva and GCF making it a potential useful tool for identifying the need for periodontal treatment in patients with advanced HF.