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Circulation. 2001;103:2055-2059

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(Circulation. 2001;103:2055.)
© 2001 American Heart Association, Inc.


Clinical Investigation and Reports

Cytokines and Cytokine Receptors in Advanced Heart Failure

An Analysis of the Cytokine Database from the Vesnarinone Trial (VEST)

Anita Deswal, MD; Nancy J. Petersen, PhD; Arthur M. Feldman, MD, PhD; James B. Young, MD; Bill G. White, PhD; Douglas L. Mann, MD

From the Winters Center for Heart Failure Research, Cardiology Section, Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Tex (A.D., D.L.M.); the Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Tex (N.J.P.); the Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa (A.M.F.); the Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.); and Clinical Cardiovascular Research, Gaithersburg, Md (B.G.W.).

Correspondence and reprint requests to Douglas L. Mann, MD, Cardiology Research (151C), Houston VAMC, 2002 Holcombe Blvd, Houston, TX 77030. E-mail dmann{at}bcm.tmc.edu


*    Abstract
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Background—Previous reports have shown that elevated circulating levels of cytokines and/or cytokine receptors predict adverse outcomes in patients with heart failure. However, these studies were limited by small numbers of patients and/or they were performed in a single center. In addition, these studies did not have sufficient size to address the influence of age, race, sex, and cause of heart failure on the circulating levels of these inflammatory mediators in patients with heart failure.

Methods and Results—We analyzed circulating levels of cytokines (tumor necrosis factor [TNF] and interleukin-6) and their cognate receptors in 1200 consecutive patients who were enrolled in a multicenter clinical trial of patients with advanced heart failure. This analysis constitutes the largest analysis of cytokines and cytokine receptors to date. Analysis of the patients receiving placebo showed that increasing circulating levels of TNF, interleukin-6, and the soluble TNF receptors were associated with increased mortality. In men, there was a linear increase in circulating levels of TNF with advancing age. Women <=50 years of age had relatively low levels of TNF, but TNF levels were disproportionately higher in women >50 years of age. No differences existed in cytokines and/or cytokine receptors in whites versus nonwhites, and circulating levels of cytokines and cytokine receptors were significantly greater in patients with ischemic heart disease.

Conclusions—Cytokines and cytokine receptors are independent predictors of mortality in patients with advanced heart failure. Moreover, circulating levels of cytokines are modified by age, sex, and cause of heart failure.


Key Words: heart failure • cytokines • tumor necrosis factor


*    Introduction
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Since the original observation that circulating levels of tumor necrosis factor (TNF) were elevated in patients with heart failure, there have been countless reports in which elevated levels of proinflammatory cytokines and/or their cytokine receptors have been observed in patients with heart failure.1 Thus far, prior studies have shown that circulating levels of TNF and interleukin-6 (IL-6) are elevated in direct relation to deteriorating functional class of heart failure.2 3 4 Moreover, previous reports have suggested that elevated levels of cytokines and cytokine receptors predict a worse clinical outcome in patients with heart failure.2 5 6 7 8 However, the clinical significance of these studies is uncertain for 2 reasons. (1) They were performed in small numbers of patients, and (2) many of the studies were performed in a single center, in which systematic referral bias is perhaps unavoidable. In addition to the above limitations, no previous study has had sufficient size to address a number of important issues relating to the elaboration of cytokines and cytokine receptors in heart failure, including the influence of age, sex, race, and cause of heart failure on cytokines and cytokine receptors.

To address the limitations of the above studies, we performed a systematic analysis of cytokines and their cognate cytokine receptors in a large-scale, multicenter, clinical trial in patients with advanced heart failure: the Vesnarinone trial (VEST).9 The present analysis, which was performed in 1200 consecutive patients with advanced heart failure, constitutes the largest analysis of cytokines and cytokine receptors that has been performed to date.


*    Methods
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Patient Population
The patient population consisted of the first consecutive 1200 patients enrolled in VEST.9 The patient population was drawn from 189 different clinical sites in North America. A total of 31 patients were excluded from the final data analysis because of protocol violations (18 patients were in New York Heart Association [NYHA] class II at the time of enrollment, and 13 had inadequate baseline blood samples). Thus, the final patient cohort consisted of 1169 patients.

Circulating Levels of Cytokines and Cytokine Receptors
Circulating levels of TNF, IL-6, soluble TNF receptor 1 (sTNFR1), soluble TNF receptor 2 (sTNFR2), and soluble IL-6 receptor (sIL-6R) were measured at baseline before randomization into VEST. If the patient had a recent infection, the cytokine and cytokine receptors were drawn 2 weeks after the resolution of the most recent infection. All patients were on stable doses of ACE inhibitors, diuretics, digoxin, and/or vasodilators for 30 days before obtaining baseline measurements. Circulating levels of cytokines and cytokine receptors were measured using an ELISA (R&D Systems) that measures "total" TNF and IL-6 (ie, free [unbound] cytokine and cytokine bound to receptors; see Data Supplement for details). After completing the cytokine analysis, the relevant demographic and clinical data corresponding to these samples were obtained from the VEST Data Coordinating Center at the University of Wisconsin in Madison, Wisconsin.

Statistical Analysis
All data are presented as mean±SEM. Because the cytokine data were not normally distributed, data were subjected to logarithmic transformation before all statistical analyses. However, to permit comparison with results from other studies, the cytokine data are presented as the mean±SEM of the untransformed data. Student’s t test was used to test for differences in continuous variables, and the {chi}2 test was used for categorical variables. Tests for differences in cytokine levels by race were performed using ANOVA. Correlations of cytokine levels with demographic characteristics were performed using Pearson’s product-moment correlations. ANCOVA was used to correct for differences in baseline characteristics and to evaluate differences in levels of cytokines and receptors between certain subgroups. Survival curves for cytokine groups were calculated by the Kaplan-Meier method, and survival among groups was compared using the log-rank test. The prognostic value of increased cytokine and cytokine receptor levels was examined using a Cox proportional-hazards model (SAS for Windows, version 6.12). Significant differences were said to exist at P<0.05 for all parameters except for correlations, which were considered to be significant at P<0.01 due to multiple comparisons.


*    Results
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Baseline Characteristics of the Study Population
As shown in Table 1Down the age, left ventricular ejection fraction, serum sodium, body weight, and Minnesota living with heart failure scores were significantly different in the patients with NYHA class III and IV heart failure, reflecting the greater degree of disease severity in the patients with class IV heart failure. The demographic and biochemical characteristics of the patients enrolled in the cytokine analysis of VEST were similar to the data reported for the overall cohort of patients enrolled in VEST.9


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Table 1. Patient Demographics

Circulating Levels of Cytokines and Cytokine Receptors in Heart Failure
The baseline levels of sTNFR1, sTNFR2, and IL-6 were significantly greater in the patients with class IV heart failure when compared with class III heart failure patients, but no significant differences existed in the plasma TNF levels in patients with NYHA class III and IV heart failure (Data Supplement). Figure 1Down illustrates the distribution of circulating TNF and IL-6 levels as a function of NYHA functional class. The important finding illustrated by these figures is that there was a great deal of overlap of both TNF and IL-6 levels in patients with NYHA class III and IV heart failure, suggesting that the elaboration of proinflammatory cytokines is not strictly confined to patients with end-stage heart failure.



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Figure 1. Circulating levels of TNF and IL-6. Circulating levels of TNF and IL-6 were grouped into 2 to 3 pg/mL increments for patients with NYHA class III and IV heart failure, and degree of overlap of circulating cytokine levels was examined for each NYHA class. Compared with values corresponding to upper limit of normal in our laboratory (>2 SDs beyond mean for age-matched subjects free of cardiovascular disease), {approx}80% of patients with NYHA class III and IV heart failure had elevated levels of TNF (upper limit of normal, 3.6 pg/mL), whereas {approx}30% of patients with NYHA class III and IV heart failure had elevated levels of IL-6 (upper limit of normal, 5.7 pg/mL).

Relationship Between Cytokines, Cytokine Receptors, and Patient Characteristics
As shown in Table 2Down, a significant positive correlation existed between patient age and circulating levels of TNF, IL-6, sTNFR1, and sTNFR2. Table 3Down compares and contrasts the circulating levels of TNF and IL-6 in men and women. Although the mean TNF level was not significantly different in men and women, a small but significant increase existed in the mean level of IL-6 in men. To determine whether there was an interaction between age and sex, we examined the relationship between age and circulating levels of TNF in men and women. The salient finding shown by Figure 2Down is that TNF levels increased linearly with age in men, whereas women had a dichotomous relationship: TNF levels remained relatively flat in women until {approx}50 years of age, and after 50 years of age, TNF levels sharply increased. Moreover, the levels of TNF in women after age 50 were relatively greater than the levels observed in men up until 70 years of age, at which time the circulating levels of TNF became similar in the 2 groups. This significant interaction (P<0.05) between patient sex and age was not observed for IL-6, sTNFR1, sTNFR2, or sIL-6R (data not shown).


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Table 2. Correlation of Age With Circulating Levels of Cytokines and Cytokine Receptor Levels


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Table 3. Cytokine Levels in Patient Subsets



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Figure 2. Sex-related differences in circulating TNF levels. Circulating levels of TNF were examined in relation to increasing patient age (10-year increments) in male and female patients with NYHA class III and IV heart failure (numbers in parentheses indicate number of subjects in each age group; P<0.05 for interaction between TNF levels by age group and sex).

Table 3Up shows that the levels of TNF and IL-6 were significantly increased in patients with ischemic heart disease. Similarly, levels of sTNFR1, sTNFR2, and sIL-6R were also significantly higher in patients with ischemic heart disease when compared with those in patients with dilated cardiomyopathy (data not shown). These differences persisted even after correcting for baseline characteristics including age, sex, NYHA class of heart failure, ejection fraction, and serum sodium. We also examined circulating levels of TNF and IL-6 as a function of race (white, black, and Hispanic), smoking status, and history of alcohol consumption. Table 3Up shows that no significant difference existed in either TNF or IL-6 levels for any of these subgroups of patients.

Relationship Between Cytokines, Cytokine Receptors, and Mortality
To determine whether circulating levels of cytokines and/or cytokine receptors predicted adverse outcomes, we examined the relationship between cytokines and/or cytokine receptors and patient mortality in the group of patients who received placebo (NYHA class III, 352 patients; NYHA class IV, 32 patients). The baseline clinical characteristics of the placebo group were similar to the patients who received active therapy (data not shown). At the end of the follow-up period (mean duration, 55 weeks; maximum duration, 78 weeks), 65 patients (16.9%) died and 319 patients (83.1%) were alive. As shown in Table 4Down, the baseline levels of TNF, IL-6, sTNFR1, and sTNFR2 were significantly higher in the group of patients who died during follow-up, whereas the circulating levels of sIL-6R were not significantly different in survivors and nonsurvivors.


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Table 4. Circulating Levels of Cytokines and Cytokine Receptors in Survivors and Nonsurvivors

We next asked whether mortality increased as a function of increasing levels of cytokines and/or cytokine receptors. Figure 3ADown shows that a significant overall difference existed in survival as a function of increasing TNF levels (P<0.007 by log-rank test), with the worst survival in patients who had TNF levels >75th percentile. Similar findings were observed with respect to the Kaplan-Meier analysis of circulating levels of IL-6 and sTNFR1, which showed that a significant overall difference existed in survival as a function of increasing levels of IL-6 (Figure 3BDown; P=0.007) and sTNFR1 (Figure 3CDown; P=0.0001), with the worst survival observed for circulating levels of IL-6 and sTNFR1 that were >75th percentile. As shown in Figure 3DDown, survival also decreased with increasing levels of sTNFR2 (Figure 3DDown; P=0.0001), with the worst survival for circulating levels of sTNFR2 >50th percentile. A univariate Cox analysis showed that TNF (P=0.01), IL-6 (P=0.0003), sTNFR1 (P=0.0001), and sTNFR2 (P=0.0001) were significant univariate predictors of mortality.



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Figure 3. Kaplan Meier survival analysis. Circulating levels of TNF (A), IL-6 (B), sTNFR1 (C), and sTNFR2 (D) were examined in relation to patient survival during follow-up (mean duration, 55 weeks; maximum duration, 78 weeks). For this analysis, circulating levels of cytokines and cytokine receptors were arbitrarily divided into quartiles.

We then entered each cytokine and/or cytokine receptor separately into a multivariate Cox proportional hazards model that included age, sex, cause of heart failure, NYHA class, ejection fraction, and serum sodium; the analysis was then performed using a backward elimination procedure. TNF (P=0.02), IL-6 (0.002), sTNFR1 (P=0.0001), and sTNFR2 (P=0.0001) remained significant independent predictors of mortality; NYHA class and ejection fraction were also retained in the statistical model as independent predictors of mortality. When all the cytokines and receptors were entered into the model together, only sTNFR2 remained a significant predictor of mortality, along with NYHA class and ejection fraction (Data Supplement). Finally, no significant difference existed in any of these parameters in the patients who died of pump failure or sudden death (Data Supplement).


*    Discussion
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The results of the present study, in which we examined the levels of cytokines and cytokine receptors in a well-characterized database obtained from a large multicenter clinical trial, provide answers to several of the important questions that were raised at the outset of this study. With respect to the first question of whether circulating levels of cytokines and/or cytokine receptors predict adverse outcomes in patients with heart failure, the data (placebo group) suggest that circulating levels of TNF, IL-6, sTNFR1, and sTNFR2 are independent predictors of increased mortality in patients with advanced heart failure. This statement is supported by the following information.

First, the baseline levels of TNF, IL-6, sTNFR1, and sTNFR2 were significantly higher in the nonsurvivors than in the survivors (Table 4Up). Interestingly, the circulating levels of TNF and IL-6 were not different in the patients who died suddenly compared with those patients who died from pump failure (Data Supplement). Second, Kaplan-Meier analyses (Figure 3Up) showed that patient survival decreased as a function of increasing levels of cytokines and/or cytokine receptors: indeed, circulating levels of TNF, IL-6, sTNFR1, and sTNFR2 >75th percentile were associated with the worst survival. In contrast, circulating levels of sIL-6R levels were not significantly different in the survivors and nonsurvivors. Third, a multivariate Cox proportional hazards model showed that circulating levels of TNF, IL-6, sTNFR1 and sTNFR2 were significant independent predictors of mortality. Thus, these findings are consistent with several previous studies.2 6 8

Interestingly, circulating levels of TNFR2 were the best independent overall predictor of mortality when cytokines and cytokine receptors were simultaneously entered into the multivariate model. This latter finding is consistent with a smaller study by Ferrari et al,5 but differs from that of Rauchhaus et al,8 who reported that TNFR1 was the single best predictor of mortality in patients with heart failure. Although the reasons for this discrepancy are unknown, they may relate to differences in patient demographics between the studies (eg, tertiary care referral center versus multicenter clinical trial population). Given that circulating soluble TNF receptors are thought to be biologically inert,10 it is not clear whether circulating levels of sTNFR2 represent an epiphenomenon that is associated with, but not causally related to, worsening disease severity. In this regard, it is interesting to note that circulating levels of sTNFR2 are thought to reflect increased activity of TNF-{alpha}–converting enzyme,11 a membrane-bound enzyme that cleaves both TNF and TNFR2 from cell surface membranes. Importantly, TNF-{alpha}–converting enzyme levels correlate with the degree of LV systolic dysfunction in patients with dilated cardiomyopathy.12 Thus, circulating levels of sTNFR2 may be a "surrogate marker" for worsening LV function and/or LV remodeling and may thus predict worsening outcomes. Alternatively, it is possible that circulating levels of sTNFR2 are causally linked to adverse outcomes in heart failure, insofar as sTNFR2 is thought to act as a "carrier protein" that is capable of binding to TNF and then slowly releasing this potentially toxic cytokine into the circulation.13 However, it should be noted that because patients enrolled in this study had advanced heart failure, the prognostic significance of circulating cytokines or their receptors in mild heart failure cannot be assessed from this database.

With respect to the second set of questions regarding the influence of age, sex, race, and cause of heart failure on cytokines and cytokine receptors, the aggregate data provide several new and important insights that are not available from smaller data sets. For example, we observed that there was an important interaction between age and sex in patients with heart failure. Although we observed that there was an overall increase in the level of circulating cytokines and cytokine receptors with advancing age, as has been reported in aging subjects who are free of cardiovascular disease,14 the age-related changes that were observed were different in men and women. Although TNF levels increased linearly with age in men with heart failure, TNF levels remained relatively flat in women until {approx}50 years of age, after which TNF levels in women abruptly increased. Although the mechanism(s) for this finding is not known, it is tempting to speculate that increased levels of estrogen in the women <=50 years of age (presumably premenopausal) may have suppressed circulating levels of TNF. Indeed, several studies have demonstrated that estrogens inhibit TNF production in a variety of different cell types, including monocytes and osteoblasts.15 Nonetheless, these studies should be regarded as provisional given the relatively small number of female patients in each age group.

A second finding that was not anticipated from the clinical literature was that circulating levels of cytokines and cytokine receptors were consistently higher in patients with ischemic cardiomyopathy than in patients with dilated cardiomyopathy (Table 3Up). Importantly, these differences persisted even after correcting for baseline characteristics between the 2 groups, including, age, sex, NYHA class, ejection fraction, and serum sodium. Because myocardial ischemia is a known trigger for myocardial biosynthesis of TNF and IL-6, these observations raise the interesting possibility that episodic bouts of myocardial ischemia may contribute to the total cytokine burden in heart failure and thus contribute to disease progression and worsening outcomes in patients with ischemic cardiomyopathy. Alternatively, the higher levels of cytokines may be reflective of the generalized inflammatory process that has been observed in atherosclerotic heart disease.

Given the recent interest in differences in heart failure outcomes on the basis of race,16 we were also interested in determining whether there were potential differences in cytokine and/or cytokine receptor levels in different racial groups in VEST. There were no obvious differences in the levels of cytokines (Table 3Up) and/or cytokine receptors between whites, blacks, and Hispanics. However, the data on cytokine levels in Hispanics should be regarded as provisional, because levels were obtained in only a limited number of Hispanic patients. Insofar as there seem to be differences in the frequency of TNF polymorphisms and cytokine responses in blacks and whites, this question remains an important area of discovery for the future.


*    Conclusions
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up arrowIntroduction
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*Conclusions
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The current analysis of cytokines and cytokines receptors in this large multicenter clinical trial bears a striking resemblance to prior analyses of neurohormonal markers, which have also been shown to be independent predictors of increased mortality in patients with heart failure.17 Although elevated levels of circulating neurohormones were once considered epiphenomena that were not related to disease progression in heart failure,17 the results of numerous clinical trials, wherein neurohormonal systems have been systematically antagonized, suggests that circulating neurohormones may contribute to disease progression in heart failure by virtue of their toxic effects on the heart and the peripheral circulation. Thus, the results of the present study suggest that, analogous to the classical neurohormones, cytokines may also represent an important therapeutic target in patients with heart failure. Indeed, this question is currently being addressed in ongoing multicenter clinical trials.


*    Acknowledgments
 
The authors gratefully acknowledge the indefatigable technical assistance of Dorellyn Lee-Jackson, Wendy Skinner, and Adrienne Chee. We also thank Dr Andrew I. Schafer for his past and present support and guidance. This research was supported by Otsuka America Pharmaceuticals, Inc. Dr Deswal is the recipient of a Clinical Research Career Development Award (CRCD No. 712B) from the Veterans Affairs Cooperative Studies Program.


*    Footnotes
 
Data Supplement can be found at www.circulationaha.org

Guest Editor for this article was Peter P. Liu, MD, FRCPC, FACC, Toronto Hospital, Toronto, Ontario, Canada.

Received October 9, 2000; revision received January 8, 2001; accepted January 26, 2001.


*    References
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*References
 
1. Dibbs Z, Kurrelmeyer K, Kalra D, et al. Cytokines in heart failure: pathogenetic mechanisms and potential treatment. Proc Assoc Am Physicians. 1999;111:423–428.[Medline] [Order article via Infotrieve]

2. Torre-Amione G, Kapadia S, Benedict CR, et al. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the studies of left ventricular dysfunction (SOLVD). J Am Coll Cardiol. 1996;27:1201–1206.[Abstract]

3. Testa M, Yeh M, Lee P, et al. Circulating levels of cytokines and their endogenous modulators in patients with mild to severe congestive heart failure due to coronary artery disease or hypertension. J Am Coll Cardiol. 1996;28:964–971.[Abstract]

4. Munger MA, Johnson B, Amber IJ, et al. Circulating concentrations of proinflammatory cytokines in mild or moderate heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1996;77:723–727.[Medline] [Order article via Infotrieve]

5. Ferrari R, Bachetti T, Confortini R, et al. Tumor necrosis factor soluble receptors in patients with various degrees of congestive failure. Circulation. 1995;92:1479–1486.[Abstract/Free Full Text]

6. Tsutamoto T, Hisanaga T, Wada A, et al. Interleukin-6 spillover in the peripheral circulation increases with the severity of heart failure, and the high plasma level of interleukin-6 is an important prognostic predictor in patients with congestive heart failure. J Am Coll Cardiol. 1998;31:391–398.[Abstract/Free Full Text]

7. Seta Y, Shan K, Bozkurt B, et al. Basic mechanisms in heart failure: the cytokine hypothesis. J Card Fail. 1996;2:243–249.[Medline] [Order article via Infotrieve]

8. Rauchhaus M, Doehner W, Francis DP, et al. Plasma cytokine parameters and mortality in patients with chronic heart failure. Circulation. 2000;102:3060–3067.[Abstract/Free Full Text]

9. Cohn JN, Goldstein SO, Greenberg BH, et al. A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure: Vesnarinone Trial Investigators. N Engl J Med. 1998;339:1810–1816.[Abstract/Free Full Text]

10. Kapadia S, Torre-Amione G, Yokoyama T, et al. Soluble tumor necrosis factor binding proteins modulate the negative inotropic effects of TNF-{alpha} in vitro. Am J Physiol. 1995;37:H517–H525.

11. Solomon KA, Pesti N, Wu G, et al. Cutting edge: a dominant negative form of TNF-alpha converting enzyme inhibits proTNF and TNFRII secretion. J Immunol. 1999;163:4105–4108.[Abstract/Free Full Text]

12. Satoh M, Nakamura M, Saitoh H, et al. Tumor necrosis factor-{alpha}-converting enzyme and tumor necrosis factor-{alpha} in human dilated cardiomyopathy. Circulation. 1999;99:3260–3265.[Abstract/Free Full Text]

13. Mohler KM, Torrance DS, Smiht CA, et al. Soluble tumor necrosis factor (TNF) receptors are effective therapeutic agents in lethal endotoxemia and function simultaneously as both TNF carriers and TNF antagonists. J Immunol. 1993;151:1548–1561.[Abstract]

14. Hasegawa Y, Sawada M, Ozaki N, et al. Increased soluble tumor necrosis factor receptor levels in the serum of elderly people. Gerontology. 2000;46:185–188.[Medline] [Order article via Infotrieve]

15. Shanker G, Sorci-Thomas M, Adams MR. Estrogen modulates the expression of tumor necrosis factor-{alpha} mRNA in phorbol ester-stimulated human monocytic THP-1 cells. Lymphokine Cytokine Res. 1994;13:377–382.[Medline] [Order article via Infotrieve]

16. Dries DL, Exner DV, Gersh BJ, et al. Racial differences in the outcome of left ventricular dysfunction. N Engl J Med. 1999;340:609–616.[Abstract/Free Full Text]

17. Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819–823. [Abstract]




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Exp PhysiolHome page
J. Freeling, K. Wattier, C. LaCroix, and Y.-F. Li
Neostigmine and pilocarpine attenuated tumour necrosis factor {alpha} expression and cardiac hypertrophy in the heart with pressure overload
Exp Physiol, January 1, 2008; 93(1): 75 - 82.
[Abstract] [Full Text] [PDF]


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Ann Rheum DisHome page
S Metyas, D La, and D G Arkfeld
The use of the tumour necrosis factor antagonist infliximab in heart transplant recipients: two case reports
Ann Rheum Dis, November 1, 2007; 66(11): 1544 - 1545.
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J Am Coll CardiolHome page
J. E. Toblli, A. Lombrana, P. Duarte, and F. Di Gennaro
Intravenous Iron Reduces NT-Pro-Brain Natriuretic Peptide in Anemic Patients With Chronic Heart Failure and Renal Insufficiency
J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1657 - 1665.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
N. A. Turner, R. S. Mughal, P. Warburton, D. J. O'Regan, S. G. Ball, and K. E. Porter
Mechanism of TNF{alpha}-induced IL-1{alpha}, IL-1{beta} and IL-6 expression in human cardiac fibroblasts: Effects of statins and thiazolidinediones
Cardiovasc Res, October 1, 2007; 76(1): 81 - 90.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. M. Felker, L. A. Allen, S. J. Pocock, L. K. Shaw, J. J.V. McMurray, M. A. Pfeffer, K. Swedberg, D. Wang, S. Yusuf, E. L. Michelson, et al.
Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank
J. Am. Coll. Cardiol., July 3, 2007; 50(1): 40 - 47.
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Eur J Heart FailHome page
M. Schaufelberger, I. Ekman, E. Bjornsson, E. Kalaitzakis, and T. Ekman
Intestinal paracellular permeability is not affected in chronic congestive heart failure
Eur J Heart Fail, June 1, 2007; 9(6-7): 574 - 578.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
Y. Yu, Y.-M. Kang, Z.-H. Zhang, S.-G. Wei, Y. Chu, R. M. Weiss, and R. B. Felder
Increased Cyclooxygenase-2 Expression in Hypothalamic Paraventricular Nucleus in Rats With Heart Failure: Role of Nuclear Factor {kappa}B
Hypertension, March 1, 2007; 49(3): 511 - 518.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
F. Zannad, E. Huvelle, K. Dickstein, D. J. van Veldhuisen, C. Stellbrink, L. Kober, S. Cazeau, P. Ritter, A. P. Maggioni, R. Ferrari, et al.
Left bundle branch block as a risk factor for progression to heart failure
Eur J Heart Fail, January 1, 2007; 9(1): 7 - 14.
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Eur J Heart FailHome page
A. Trikas, C. Antoniades, G. Latsios, K. Vasiliadou, I. Karamitros, D. Tousoulis, C. Tentolouris, and C. Stefanadis
Long-term effects of levosimendan infusion on inflammatory processes and sFas in patients with severe heart failure
Eur J Heart Fail, December 1, 2006; 8(8): 804 - 809.
[Abstract] [Full Text] [PDF]


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J. Appl. Physiol.Home page
G. S. Hoare, E. J. Birks, C. Bowles, N. Marczin, and M. H. Yacoub
In vitro endothelial cell activation and inflammatory responses in end-stage heart failure
J Appl Physiol, November 1, 2006; 101(5): 1466 - 1473.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
L. C. van Vark, I. Kardys, G. S. Bleumink, A. M. Knetsch, J. W. Deckers, A. Hofman, B. H.Ch. Stricker, and J. C.M. Witteman
Lipoprotein-associated phospholipase A2 activity and risk of heart failure: the Rotterdam Study
Eur. Heart J., October 1, 2006; 27(19): 2346 - 2352.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
N. Valeur, O. W. Nielsen, J. J.V. McMurray, C. Torp-Pedersen, L. Kober, and TRACE Study Group
Anaemia is an independent predictor of mortality in patients with left ventricular systolic dysfunction following acute myocardial infarction
Eur J Heart Fail, October 1, 2006; 8(6): 577 - 584.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
Y. Li, G. Takemura, H. Okada, S. Miyata, R. Maruyama, L. Li, M. Higuchi, S. Minatoguchi, T. Fujiwara, and H. Fujiwara
Reduction of inflammatory cytokine expression and oxidative damage by erythropoietin in chronic heart failure
Cardiovasc Res, September 1, 2006; 71(4): 684 - 694.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
S. Genth-Zotz, S. von Haehling, A. P. Bolger, P. R. Kalra, R. Wensel, A. J.S. Coats, H.-D. Volk, and S. D. Anker
The anti-CD14 antibody IC14 suppresses ex vivo endotoxin stimulated tumor necrosis factor-alpha in patients with chronic heart failure
Eur J Heart Fail, June 1, 2006; 8(4): 366 - 372.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
E. A. Jankowska, P. Ponikowski, M. F. Piepoli, W. Banasiak, S. D. Anker, and P. A. Poole-Wilson
Autonomic imbalance and immune activation in chronic heart failure - Pathophysiological links
Cardiovasc Res, June 1, 2006; 70(3): 434 - 445.
[Abstract] [Full Text] [PDF]


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CirculationHome page
Y.-D. Tang and S. D. Katz
Anemia in Chronic Heart Failure: Prevalence, Etiology, Clinical Correlates, and Treatment Options
Circulation, May 23, 2006; 113(20): 2454 - 2461.
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J. Leukoc. Biol.Home page
H.-P. Yu, T. Shimizu, Y.-C. Hsieh, T. Suzuki, M. A. Choudhry, M. G. Schwacha, and I. H. Chaudry
Tissue-specific expression of estrogen receptors and their role in the regulation of neutrophil infiltration in various organs following trauma-hemorrhage
J. Leukoc. Biol., May 1, 2006; 79(5): 963 - 970.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. Odeh, E. Sabo, and A. Oliven
Circulating levels of tumor necrosis factor-{alpha} correlate positively with severity of peripheral oedema in patients with right heart failure
Eur J Heart Fail, March 1, 2006; 8(2): 141 - 146.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
S. Rutschow, J. Li, H.-P. Schultheiss, and M. Pauschinger
Myocardial proteases and matrix remodeling in inflammatory heart disease
Cardiovasc Res, February 15, 2006; 69(3): 646 - 656.
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J Am Coll CardiolHome page
S. Sola, M. Q.S. Mir, S. Lerakis, N. Tandon, and B. V. Khan
Atorvastatin Improves Left Ventricular Systolic Function and Serum Markers of Inflammation in Nonischemic Heart Failure
J. Am. Coll. Cardiol., January 17, 2006; 47(2): 332 - 337.
[Abstract] [Full Text] [PDF]


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J Med MicrobiolHome page
S. Yazar, M. Gur, I. Ozdogru, O. Yaman, A. Oguzhan, and I. Sahin
Anti-Toxoplasma gondii antibodies in patients with chronic heart failure
J. Med. Microbiol., January 1, 2006; 55(1): 89 - 92.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
A. Krack, R. Sharma, H. R. Figulla, and S. D. Anker
The importance of the gastrointestinal system in the pathogenesis of heart failure
Eur. Heart J., November 2, 2005; 26(22): 2368 - 2374.
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J. Leukoc. Biol.Home page
V. C. Mehra, V. S. Ramgolam, and J. R. Bender
Cytokines and cardiovascular disease
J. Leukoc. Biol., October 1, 2005; 78(4): 805 - 818.
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Eur J Heart FailHome page
E. A. Jankowska, S. von Haehling, A. Czarny, E. Zaczynska, A. Kus, S. D. Anker, W. Banasiak, and P. Ponikowski
Activation of the NF-{kappa}B system in peripheral blood leukocytes from patients with chronic heart failure
Eur J Heart Fail, October 1, 2005; 7(6): 984 - 990.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
S. Grundmann, I. Hoefer, S. Ulusans, N. van Royen, S. H. Schirmer, C. K. Ozaki, C. Bode, J. J. Piek, and I. Buschmann
Anti-tumor necrosis factor-{alpha} therapies attenuate adaptive arteriogenesis in the rabbit
Am J Physiol Heart Circ Physiol, October 1, 2005; 289(4): H1497 - H1505.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
A. O. Mocelin, V. S. Issa, F. Bacal, G. V. Guimaraes, E. Cunha, and E. A. Bocchi
The influence of aetiology on inflammatory and neurohumoral activation in patients with severe heart failure: A prospective study comparing Chagas' heart disease and idiopathic dilated cardiomyopathy
Eur J Heart Fail, August 1, 2005; 7(5): 869 - 873.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
C. Avgeropoulou, I. Andreadou, S. Markantonis-Kyroudis, M. Demopoulou, P. Missovoulos, A. Androulakis, and I. Kallikazaros
The Ca2+-sensitizer levosimendan improves oxidative damage, BNP and pro-inflammatory cytokine levels in patients with advanced decompensated heart failure in comparison to dobutamine
Eur J Heart Fail, August 1, 2005; 7(5): 882 - 887.
[Abstract] [Full Text] [PDF]


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CirculationHome page
H. Fukuta, D. C. Sane, S. Brucks, and W. C. Little
Statin Therapy May Be Associated With Lower Mortality in Patients With Diastolic Heart Failure: A Preliminary Report
Circulation, July 19, 2005; 112(3): 357 - 363.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Cell Physiol.Home page
C. L. Speyer, N. J. Rancilio, S. D. McClintock, J. D. Crawford, H. Gao, J. V. Sarma, and P. A. Ward
Regulatory effects of estrogen on acute lung inflammation in mice
Am J Physiol Cell Physiol, April 1, 2005; 288(4): C881 - C890.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Valgimigli, C. Ceconi, P. Malagutti, E. Merli, O. Soukhomovskaia, G. Francolini, G. Cicchitelli, A. Olivares, G. Parrinello, G. Percoco, et al.
Tumor Necrosis Factor-{alpha} Receptor 1 Is a Major Predictor of Mortality and New-Onset Heart Failure in Patients With Acute Myocardial Infarction: The Cytokine-Activation and Long-Term Prognosis in Myocardial Infarction (C-ALPHA) Study
Circulation, February 22, 2005; 111(7): 863 - 870.
[Abstract] [Full Text] [PDF]


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Arch Intern MedHome page
J. P. Curtis, J. G. Selter, Y. Wang, S. S. Rathore, I. S. Jovin, F. Jadbabaie, M. Kosiborod, E. L. Portnay, S. I. Sokol, F. Bader, et al.
The Obesity Paradox: Body Mass Index and Outcomes in Patients With Heart Failure
Arch Intern Med, January 10, 2005; 165(1): 55 - 61.
[Abstract] [Full Text] [PDF]


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HeartHome page
N Wisniacki, W Taylor, M Lye, and J P H Wilding
Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure
Heart, January 1, 2005; 91(1): 32 - 37.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. Satoh, J. Iwasaka, M. Nakamura, T. Akatsu, Y. Shimoda, and K. Hiramori
Increased expression of tumor necrosis factor-{alpha} converting enzyme and tumor necrosis factor-{alpha} in peripheral blood mononuclear cells in patients with advanced congestive heart failure
Eur J Heart Fail, December 1, 2004; 6(7): 869 - 875.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
K. E. Porter, N. A. Turner, D. J. O'Regan, and S. G. Ball
Tumor necrosis factor {alpha} induces human atrial myofibroblast proliferation, invasion and MMP-9 secretion: inhibition by simvastatin
Cardiovasc Res, December 1, 2004; 64(3): 507 - 515.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
A. P. Patrianakos, F. I. Parthenakis, E. A. Papadimitriou, G. F. Diakakis, P. G. Tzerakis, D. Nikitovic, and P. E. Vardas
Restrictive filling pattern is associated with increased humoral activation and impaired exercise capacity in dilated cardiomyopathy
Eur J Heart Fail, October 1, 2004; 6(6): 735 - 743.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
L. Rossig, S. Fichtlscherer, C. Heeschen, J. Berger, S. Dimmeler, and A. M. Zeiher
The pro-apoptotic serum activity is an independent mortality predictor of patients with heart failure
Eur. Heart J., September 2, 2004; 25(18): 1620 - 1625.
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J Am Coll CardiolHome page
G.M. Felker, K. F. Adams Jr, W. A. Gattis, and C. M. O'Connor
Anemia as a risk factor and therapeutic target in heart failure
J. Am. Coll. Cardiol., September 1, 2004; 44(5): 959 - 966.
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J Am Coll CardiolHome page
S. S. Pedersen, P. A. Lemos, P. R. van Vooren, T. K.K. Liu, J. Daemen, R. A.M. Erdman, P. C. Smits, P. W.J.C. Serruys, and R. T. van Domburg
Type D personality predicts death or myocardial infarction after bare metal stent or sirolimus-eluting stent implantation: A rapamycin-eluting stent evaluated at rotterdam cardiology hospital (RESEARCH) registry substudy
J. Am. Coll. Cardiol., September 1, 2004; 44(5): 997 - 1001.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. Valgimigli, E. Merli, P. Malagutti, O. Soukhomovskaia, G. Cicchitelli, A. Antelli, D. Canistro, G. Francolini, G. Macri, F. Mastrorilli, et al.
Hydroxyl radical generation, levels of tumor necrosis factor-alpha, and progression to heart failure after acute myocardial infarction
J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2000 - 2008.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
V. M. Conraads, P. G. Jorens, L. S. De Clerck, H. K. Van Saene, M. M. Ieven, J. M. Bosmans, A. Schuerwegh, C. H. Bridts, F. Wuyts, W. J. Stevens, et al.
Selective intestinal decontamination in advanced chronic heart failure: a pilot trial
Eur J Heart Fail, June 1, 2004; 6(4): 483 - 491.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
J. Francis, Y. Chu, A. K. Johnson, R. M. Weiss, and R. B. Felder
Acute myocardial infarction induces hypothalamic cytokine synthesis
Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2264 - H2271.
[Abstract] [Full Text] [PDF]


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CirculationHome page
Y. Higuchi, C. F. McTiernan, C. B. Frye, B. S. McGowan, T. O. Chan, and A. M. Feldman
Tumor Necrosis Factor Receptors 1 and 2 Differentially Regulate Survival, Cardiac Dysfunction, and Remodeling in Transgenic Mice With Tumor Necrosis Factor-{alpha}-Induced Cardiomyopathy
Circulation, April 20, 2004; 109(15): 1892 - 1897.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
J. Wang, H. Wang, Y. Zhang, H. Gao, S. Nattel, and Z. Wang
Impairment of HERG K+ Channel Function by Tumor Necrosis Factor-{alpha}: ROLE OF REACTIVE OXYGEN SPECIES AS A MEDIATOR
J. Biol. Chem., April 2, 2004; 279(14): 13289 - 13292.
[Abstract] [Full Text] [PDF]


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ChestHome page
P. O. Scumpia, P. J. Sarcia, K. M. Kelly, V. G. DeMarco, and J. W. Skimming
Hypothermia Induces Anti-Inflammatory Cytokines and Inhibits Nitric Oxide and Myeloperoxidase-Mediated Damage in the Hearts of Endotoxemic Rats
Chest, April 1, 2004; 125(4): 1483 - 1491.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. B. Horwich, W. R. MacLellan, and G. C. Fonarow
Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure
J. Am. Coll. Cardiol., February 18, 2004; 43(4): 642 - 648.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
V. M. Conraads, J. M. Bosmans, A. J. Schuerwegh, L. S. De Clerck, C. H. Bridts, F. L. Wuyts, W. J. Stevens, and C. J. Vrints
Association of lipoproteins with cytokines and cytokine receptors in heart failure patients: Differences between ischaemic versus idiopathic cardiomyopathy
Eur. Heart J., December 2, 2003; 24(24): 2221 - 2226.
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Circ. Res.Home page
R. A. Ahokas, K. J. Warrington, I. C. Gerling, Y. Sun, L. A. Wodi, P. A. Herring, L. Lu, S. K. Bhattacharya, A. E. Postlethwaite, and K. T. Weber
Aldosteronism and Peripheral Blood Mononuclear Cell Activation: A Neuroendocrine-Immune Interface
Circ. Res., November 14, 2003; 93 (10): e124 - e135.
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J. Appl. Physiol.Home page
R. U. Pliquett, K. G. Cornish, K. P. Patel, H. D. Schultz, J. D. Peuler, and I. H. Zucker
Amelioration of depressed cardiopulmonary reflex control of sympathetic nerve activity by short-term exercise training in male rabbits with heart failure
J Appl Physiol, November 1, 2003; 95(5): 1883 - 1888.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
J. J. Jacoby, A. Kalinowski, M.-G. Liu, S. S.-M. Zhang, Q. Gao, G.-X. Chai, L. Ji, Y. Iwamoto, E. Li, M. Schneider, et al.
Cardiomyocyte-restricted knockout of STAT3 results in higher sensitivity to inflammation, cardiac fibrosis, and heart failure with advanced age
PNAS, October 28, 2003; 100(22): 12929 - 12934.
[Abstract] [Full Text] [PDF]


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Anesth. Analg.Home page
H. Tomasdottir, H. Hjartarson, A. Ricksten, C. Wasslavik, A. Bengtsson, and S.-E. Ricksten
Tumor Necrosis Factor Gene Polymorphism Is Associated with Enhanced Systemic Inflammatory Response and Increased Cardiopulmonary Morbidity After Cardiac Surgery
Anesth. Analg., October 1, 2003; 97(4): 944 - 949.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
W. C. Levy and I. B. Hirsch
Diabetes and heart failure: is insulin therapy the answer?
J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1051 - 1053.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
S. Aker, S. Belosjorow, I. Konietzka, A. Duschin, C. Martin, G. Heusch, and R. Schulz
Serum but not myocardial TNF-{alpha} concentration is increased in pacing-induced heart failure in rabbits
Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2003; 285(2): R463 - R469.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
Z.-H. Zhang, S.-G. Wei, J. Francis, and R. B. Felder
Cardiovascular and renal sympathetic activation by blood-borne TNF-alpha in rat: the role of central prostaglandins
Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2003; 284(4): R916 - R927.
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CirculationHome page
D. R. Murray and G. L. Freeman
Proinflammatory Cytokines: Predictors of a Failing Heart?
Circulation, March 25, 2003; 107(11): 1460 - 1462.
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Psychosom. Med.Home page
J. Pasic, W. C. Levy, and M. D. Sullivan
Cytokines in Depression and Heart Failure
Psychosom Med, March 1, 2003; 65(2): 181 - 193.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
R. B. Felder, J. Francis, Z.-H. Zhang, S.-G. Wei, R. M. Weiss, and A. K. Johnson
Heart failure and the brain: new perspectives
Am J Physiol Regulatory Integrative Comp Physiol, February 1, 2003; 284(2): R259 - R276.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
J. Francis, R. M. Weiss, A. K. Johnson, and R. B. Felder
Central mineralocorticoid receptor blockade decreases plasma TNF-alpha after coronary artery ligation in rats
Am J Physiol Regulatory Integrative Comp Physiol, February 1, 2003; 284(2): R328 - R335.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
V.M. Conraads, P. Beckers, J. Bosmans, L.S. De Clerck, W.J. Stevens, C.J. Vrints, and D.L. Brutsaert
Combined endurance/resistance training reduces plasma TNF-{alpha} receptor levels in patients with chronic heart failure and coronary artery disease
Eur. Heart J., December 1, 2002; 23(23): 1854 - 1860.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
D. L. Mann
Inflammatory Mediators and the Failing Heart: Past, Present, and the Foreseeable Future
Circ. Res., November 29, 2002; 91(11): 988 - 998.
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Am. J. Pathol.Home page
Y. Sun, J. Zhang, L. Lu, S. S. Chen, M. T. Quinn, and K. T. Weber
Aldosterone-Induced Inflammation in the Rat Heart : Role of Oxidative Stress
Am. J. Pathol., November 1, 2002; 161(5): 1773 - 1781.
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Am. J. Physiol. Heart Circ. Physiol.Home page
J. R. R. Heyen, E. R. Blasi, K. Nikula, R. Rocha, H. A. Daust, G. Frierdich, J. F. Van Vleet, P. De Ciechi, E. G. McMahon, and A. E. Rudolph
Structural, functional, and molecular characterization of the SHHF model of heart failure
Am J Physiol Heart Circ Physiol, November 1, 2002; 283(5): H1775 - H1784.
[Abstract] [Full Text] [PDF]


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Exp. Biol. Med.Home page
J. Zhang, Y. Liu, J. Shi, D. F. Larson, and R. R. Watson
Side-Stream Cigarette Smoke Induces Dose-Response in Systemic Inflammatory Cytokine Production and Oxidative Stress
Experimental Biology and Medicine, October 1, 2002; 227(9): 823 - 829.
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Eur Heart JHome page
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.
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J Am Coll CardiolHome page
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.
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CirculationHome page
C. M. Albert, J. Ma, N. Rifai, M. J. Stampfer, and P. M. Ridker
Prospective Study of C-Reactive Protein, Homocysteine, and Plasma Lipid Levels as Predictors of Sudden Cardiac Death
Circulation, June 4, 2002; 105(22): 2595 - 2599.
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Am. J. Physiol. Heart Circ. Physiol.Home page
W. S. Bradham, G. Moe, K. A. Wendt, A. A. Scott, A. Konig, M. Romanova, G. Naik, and F. G. Spinale
TNF-alpha and myocardial matrix metalloproteinases in heart failure: relationship to LV remodeling
Am J Physiol Heart Circ Physiol, April 1, 2002; 282(4): H1288 - H1295.
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Cardiovasc ResHome page
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.
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J Am Coll CardiolHome page
S. Adamopoulos, J. Parissis, D. Karatzas, C. Kroupis, M. Georgiadis, G. Karavolias, J. Paraskevaidis, K. Koniavitou, A. J. S. Coats, and D. T. Kremastinos
Physical training modulates proinflammatory cytokines and the soluble Fas/soluble Fasligand system in patients with chronic heart failure
J. Am. Coll. Cardiol., February 20, 2002; 39(4): 653 - 663.
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Endocr. Rev.Home page
J. Pfeilschifter, R. Koditz, M. Pfohl, and H. Schatz
Changes in Proinflammatory Cytokine Activity after Menopause
Endocr. Rev., February 1, 2002; 23(1): 90 - 119.
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HypertensionHome page
A. L. Farre and S. Casado
Heart Failure, Redox Alterations, and Endothelial Dysfunction
Hypertension, December 1, 2001; 38(6): 1400 - 1405.
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K. Krasinski, I. Spyridopoulos, M. Kearney, and D. W. Losordo
In Vivo Blockade of Tumor Necrosis Factor-{alpha} Accelerates Functional Endothelial Recovery After Balloon Angioplasty
Circulation, October 9, 2001; 104(15): 1754 - 1756.
[Abstract] [Full Text] [PDF]


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