Tumour Necrosis Factor alpha and Troponin T as predictors of poor prognosis in patients with stable heart failure.

Introduction: TNFα, a proinflammatory cytokine expressed under several conditions in the myocardium, may contribute to myocardial damage in heart failure (HF). The aim of the study was to determine TNFa concentrations and their relation to severity, mortality, and clinical, biochemical and echocardiographic parameters in patients with stable chronic heart failure. Patients and methods: In a prospective study in 128 patients with HF, average follow-up 33 mos, serum concenrations of TNFa were determined, and clinical, biochemical and echocardiographic characteristics and mortality were recorded. Serum TNFa concentrations were also determined in 35 healthy subjects. Univariate and multivariate analyses were performed to determine variables that could influence TNFα concentrations, and that could predict mortality. Results: Patients with HF have higher serum concentrations of TNFa than controls (6.72 ± 0.2 vs 5.5±0.2 pg/ml, P=0.02). Patients with functional class I had lower concenrations of TNFa than patients with functional classes II and III (P=0.05 and P=0.001, respectively). Variables associated with higher concentrations of TNFa were; lower ejection fraction (P=0.04), worse functional class (P=0.007), coronary artery disease (P=0.05), chronic renal failure (P=0.02), arterial hypertension (P=0.05), higher concentrations of epinephrine (P=0.03) and norepinephrine (P=0.05). On follow-up, factors associated with decline in ejection fraction were arterial hypertension and higher total catecholamines. factors associated with higher mortality were hypertension, elevated concentrations of TNFα and troponin T. Endothelin 1 levels correlated with worsening functional class. Conclusion: Serum TNFα and troponin T concentrations are independent predictors of severity and mortality in stable HF patients.