TUMOR-NECROSIS-FACTOR-ALPHA IN SEVERE CONGESTIVE CARDIAC-FAILURE

Objective-To examine the concentration of circulating tumour necrosis factor alpha (TNF alpha) in patients with severe congestive heart fail ure (New York Heart Association class IV) during one year and to corre late changes in this cytokine with changes in plasma noradrenaline, pl asma renin activity, and weight.Design-A prospective study of the role of TNF alpha in severe chronic heart failure. Blood samples were coll ected 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 f losequinan. Main outcome measures-Changes in TNF alpha and the correla tion with changes in plasma noradrenaline, plasma renin activity, and weight during optimal medical treatment for one year. Results-The mean concentration of TNF alpha was greater than the upper 95% confidence interval for healthy controls throughout the year of the study but the re was considerable between and within patient variation. No correlati on was seen between TNF alpha and plasma noradrenaline, plasma renin a ctivity, or weight. Conclusions-The stimulus resulting in enhanced pla sma concentrations of TNF alpha in congestive heart failure remains un clear and concentrations at any particular time were not prognostic.