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.