The Clinical Relevance of Circulating Tumor Necrosis Factor-a in Acute Decompensated Chronic Heart Failure Without Cachexia (Results)

In: Heart Failure

14 Dec 2013

The Clinical Relevance of Circulating Tumor Necrosis Factor-a in Acute Decompensated Chronic Heart Failure Without Cachexia (Results)TNFa in CHF Patients and Control Subjects

The mean concentration of TNFa in the normal control subjects was 0.89±0.40 pg/mL (range, 0.5 to 9.7 pg/mL) and was above the limit of detection (>0.5 pg/mL) in 8 subjects. Plasma concentrations of TNFa in acutely decompensated CHF patients were significantly higher (p<0.002) at 3.0±0.4 pg/mL (range, 0.5 to 6.8 pg/mL) and were above the detection limit of the assay in 22 patients (Fig 1). Furthermore, by x2 analysis, heart failure patients demonstrated a significantly higher frequency of any detectable TNFa compared with normal control subjects (22/29 vs 8/25; p<0.05).

Comparison of Groups A and B

At baseline, group B patients demonstrated statistically significant reductions in ejection fraction (0.15±0.05 vs 0.20±0.08; p<0.05), serum sodium (134±4 mmol/L vs 138±3 mmol/L; p<0.05), and mean BP (78±9 mm Hg vs 92±7 mm Hg; p<0.01) compared to group A patients, respectively. All other baseline demographic, hemodynamic, and biochemical parameters (including TNFa levels) between groups A and B were similar (Table 1).

Serial Cytokine Measurements

TNFa concentrations did not change significantly in any group from beginning to end of therapy (72 h). There were no significant differences in cytokine levels between the “decompensated” state compared to the state of “recovery” at outpatient (mean, 11 days) follow-up (Table 1).

Table 1—Demographic, Hemodynamic, and Biochemical Characteristics of 29 Patients With Decompensated Heart Failure (NYHA Class TV) According to Clinical Status

Characteristic Group A (n=6) 1Dobutamine(n=13) Group B ….. ~iMilrinone(n=10)
Age, yr 58 ±14 57 ±15 54 ±12
Ejection fraction 0.20±0.08 0.15±0.05 0.15±0.03
Mean BP, mm Hg 92±7 78±9 79±10
Serum sodium, mmol/L 138±3 135 ±4 134±4
Serum creatinine, mg/dL 1.4±0.4 1.6±0.5 1.5±0.3
BUN, mg/dL 26±9 37±15 29±11
Serum carbon dioxide, mEq/L 20±6 21±3 21±3
TNFa, pg/mL Oh 4.0±1.1 2.4±0.5 2.6±0.7
6 h 4.1±1.2 2.8±0.5 2.7±0.7
48 h 5.6±1.7 3.5±0.5 3.1±1.0
72 h 4.2±1.2 3.6±0.8 3.8±0.9
11 d 5.1±1.2 4.8±0.7 2.8±0.8

figure-1

Figure 1. Mean plasma concentrations of TNFa in 29 patients with decompensated CHF and 25 normal subjects.


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