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(Circulation. 2000;102:3060.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
From Clinical Cardiology, National Heart and Lung Institute (M.R., W.D., D.P.F., C.D., J.N., A.J.S.C., S.D.A.), and Biochemistry, Royal Brompton Hospital (M.K., J.H.), London, UK; the Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität (M.R.), Halle, Germany; and the Institut für Medizinische Immunologie, Charité (Campus Mitte) (C.L., H.-D.V.), and Franz-Volhard-Klinik (Charité, Campus Berlin-Buch) am Max-Delbrück Centrum für Molekulare Medizin (S.D.A.), Berlin, Germany.
Correspondence to Mathias Rauchhaus, MD, Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität, Ernst-Grube-Str. 40, 06097 Halle, Germany. E-mail mathias.rauchhaus{at}medizin.uni-halle.de
BackgroundInflammatory
immune activation is an important feature in chronic heart failure
(CHF). Little is known about the prognostic importance of tumor
necrosis factor-
(TNF-
), soluble TNF-receptor 1 and 2
(sTNF-R1/sTNF-R2), interleukin-6 (IL-6), and soluble CD14 receptors
(sCD14) in CHF patients.
Methods and ResultsIn
152 CHF patients (age 61±1 years, New York Heart Association [NYHA]
class 2.6±0.1, peak
O2
17.3±0.6
mL · kg-1 · min-1,
mean±SEM) plasma concentrations of immune variables were prospectively
assessed. During a mean follow-up of 34 months (>12 months in all
patients), 62 patients (41%) died. Cumulative mortality was 28% at 24
months. In univariate analyses, increased total and trimeric TNF-
,
sTNF-R1, and sTNF-R2 (all
P
0.0001), sCD14
(P=0.0007), and IL-6
(P=0.005) predicted 24-month
mortality. With multivariate analysis and receiver operating
characteristics, sTNF-R1 emerged among all cytokine parameters as the
strongest and most accurate prognosticator in this CHF population,
regardless of follow-up duration and independently of NYHA class, peak
O2,
E/
CO2
slope, left ventricular ejection fraction, and wasting
(P<0.001). The receiver
operating characteristic area under the curve for sTNF-R1 was greater
than for sTNF-R2 at 6, 12, and 18 months (all
P<0.05).
ConclusionssTNF-R1 was
the strongest and most accurate prognosticator, independent of
established markers of CHF severity. Assessment of sTNF-R1 may be
useful in identifying patients who are at high risk of death and in
monitoring patients undergoing antiTNF-
treatment.
Key Words: heart failure immune system proteins prognosis mortality
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S. Zeuke, A. J Ulmer, S. Kusumoto, H. A Katus, and H. Heine TLR4-mediated inflammatory activation of human coronary artery endothelial cells by LPS Cardiovasc Res, October 1, 2002; 56(1): 126 - 134. [Abstract] [Full Text] [PDF] |
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G. Vescovo, B. Ravara, A. Angelini, M. Sandri, U. Carraro, C. Ceconi, and L. D. Libera Effect of thalidomide on the skeletal muscle in experimental heart failure Eur J Heart Fail, August 1, 2002; 4(4): 455 - 460. [Abstract] [Full Text] [PDF] |
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W. Schillinger, H. Schneider, K. Minami, R. Ferrari, and G. Hasenfuss Importance of sympathetic activation for the expression of Na+-Ca2+ exchanger in end-stage failing human myocardium Eur. Heart J., July 2, 2002; 23(14): 1118 - 1124. [Abstract] [Full Text] [PDF] |
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P. R. Kalra, C. Anagnostopoulos, A. P. Bolger, A. J. S. Coats, and S. D. Anker The regulation and measurement of plasma volume in heart failure J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1901 - 1908. [Abstract] [Full Text] [PDF] |
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T. B. Horwich, G. C. Fonarow, M. A. Hamilton, W. R. MacLellan, and J. Borenstein Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1780 - 1786. [Abstract] [Full Text] [PDF] |
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H. Krum and J. J. McMurray Statins and chronic heart failure: do we need a large-scale outcome trial? J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1567 - 1573. [Abstract] [Full Text] [PDF] |
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R Sharma and S.D Anker From tissue wasting to cachexia: changes in peripheral blood flow and skeletal musculature Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D12 - D17. [Abstract] [PDF] |
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W. S. Bradham, B. Bozkurt, H. Gunasinghe, D. Mann, and F. G. Spinale Tumor necrosis factor-alpha and myocardial remodeling in progression of heart failure: a current perspective Cardiovasc Res, March 1, 2002; 53(4): 822 - 830. [Abstract] [Full Text] [PDF] |
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R. Kell, A. Haunstetter, T.J. Dengler, C. Zugck, W. Kubler, and M. Haass Do cytokines enable risk stratification to be improved in NYHA functional class III patients?. Comparison with other potential predictors of prognosis Eur. Heart J., January 1, 2002; 23(1): 70 - 78. [Abstract] [Full Text] [PDF] |
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A. P. Bolger, R. Sharma, P. Aukrust, L. Gullestad, H. Aass, J. G. Fjeld, L. Wikeby, A. K. Andreassen, H. Ihlen, S. Simonsen, et al. Increase in Anti-Inflammatory Cytokine Levels in Chronic Heart Failure: A Measure of Treatment Success or Failure? Response Circulation, October 30, 2001; 104 (18): e97 - e97. [Full Text] [PDF] |
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G. Zoppini, G. Faccini, M. Muggeo, L. Zenari, G. Falezza, and G. Targher Elevated Plasma Levels of Soluble Receptors of TNF-{alpha} and Their Association with Smoking and Microvascular Complications in Young Adults with Type 1 Diabetes J. Clin. Endocrinol. Metab., August 1, 2001; 86(8): 3805 - 3808. [Abstract] [Full Text] [PDF] |
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A. Deswal, N. J. Petersen, A. M. Feldman, J. B. Young, B. G. White, and D. L. Mann Cytokines and Cytokine Receptors in Advanced Heart Failure : An Analysis of the Cytokine Database from the Vesnarinone Trial (VEST) Circulation, April 24, 2001; 103(16): 2055 - 2059. [Abstract] [Full Text] [PDF] |
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W. W. Parmley How Many Medicines Do Patients With Heart Failure Need? Circulation, March 27, 2001; 103(12): 1611 - 1612. [Full Text] [PDF] |
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