PROINFLAMMATORY CYTOKINES AND CARDIAC PUM P FUNCTION

In situations of depressed myocardial function, the role of immunologi cal mechanisms has been studied recently. In different pathophysiologi cal situations, such as chronic heart failure, open heart surgery with extracorporal circulation, cardiac transplantation, myocardial infarc tion and angina pectoris, patterns have been described with elevation of proinflammatory cytokines, such as tumor necrosis factor-alpha, int erleukin-l. interleukin-6, and reversible myocardial dysfunction, whic h may represent a final common pathway. The available data suggest a m odulation of important determinants of pump function, i. e., contracti lity, preload, afterload, and heart rate, by cytokines. Potential mech anisms include the beta-adrenoceptor- and nitric oxide pathway, as wel l as a direct impact on intracellular calcium homeostasis. Interventio nal strategies based on this understanding are beginning to emerge.