Chest
Clinical Investigations: Heart Failure: ArticlesThe Clinical Relevance of Circulating Tumor Necrosis Factor-α in Acute Decompensated Chronic Heart Failure Without Cachexia
Section snippets
Study Population
The study population consisted of 29 noncachectic patients (20 men and 9 women; age range, 27 to 79 years; mean 56±13 years) with advanced CHF who demonstrated acute decompensation while receiving adequate oral medical therapy, thus requiring admission to the hospital for therapeutic intervention. Patients were excluded if they exhibited any evidence of cachexia or infectious, inflammatory, or neoplastic disease. Cachexia was considered to be present if the percentage of ideal body weight was
TNFα in CHF Patients and Control Subjects
The mean concentration of TNFα 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 TNFα 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 χ2 analysis, heart failure patients demonstrated a significantly higher frequency of any
Discussion
The findings of this investigation allow us to make two important clinical observations. First, as in other reports,13 our results allude to the higher elucidation of TNFα in patients with chronic heart failure, even in the absence of cachexia. Second, and more importantly, we were unable to demonstrate a significant improvement in elaboration of TNFα following clinical resolution of acute decompensation. Thus, in the short-term recovery period (1 to 2 weeks), no significant reduction of TNFα
CONCLUSION
This investigation demonstrates that although noncachectic patients with chronic heart failure who suffer acute decompensation elaborate significantly higher circulating levels of TNFα compared with healthy control subjects, no significant reduction or alteration in circulating TNFα is noted in the short-term follow-up despite clinical improvement.
The authors appreciate the technical expertise of Barbara Hand and Christiane Haslberger.
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