Tumour necrosis factor α in severe congestive cardiac failure

Abstract

Objective - To examine the concentration of circulating tumour necrosis factor α (TNF α) in patients with severe congestive heart failure (New York Heart Association class IV) during one year and to correlate changes in this cytokine with changes in plasma noradrenaline, plasma renin activity, and weight. Design - A prospective study of the role of TNF α in severe chronic heart failure. Blood samples were collected at intervals of three months. Setting - Medical research centre of a teaching hospital. Patients - 16 patients with chronic stable severe heart failure. Interventions - Vasodilator treatment with captopril or flosequinan. Main outcome measures - Changes in TNF α and the correlation with changes in plasma noradrenaline, plasma renin activity, and weight during optimal medical treatment for one year. Results - The mean concentration of TNF α was greater than the upper 95% but there was considerable between and within patient variation. No correlation was seen between TNF α and plasma noradrenaline, plasma renin activity, or weight. Conclusions - The stimulus resulting in enhanced plasma concentrations of TNF α in congestive heart failure remains unclear and concentrations at any particular time were not prognostic.