PRO-INFLAMMATORY CYTOKINES AND ENDOTHELIUM-DEPENDENT VASODILATION IN THE FOREARM - SERIAL ASSESSMENT IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

Background In patients with heart failure endothelium dependent vasodi lation of the forearm conduit vessels is impaired possibly because of elevated plasma levels of pro-inflammatory cytokines. The effect of el evated plasma cytokines on endothelium-dependent vasodilation of forea rm conduit vessels was therefore serially investigated in 16 patients with congestive heart failure during an episode of acute failure and a t the time of recompensation. Methods and Results Pro-inflammatory cyt okine levels and hyperaemic brachial artery diameters were obtained sh ortly after admission for an episode of acute heart failure and 11 +/- 3 days later at the time of recompensation, which was obtained using diuretic therapy without changing other cardiovascular medications. Se rum concentrations (Mean+/-SD) of tumour necrosis factor alpha (TNF-al pha) (decompensation vs recompensation: 25+/-23pg.ml(-1) vs 26 +/- 17 pg. ml(-1)) and interleukine 6 (IL-6) (decompensation vs recompensatio n: 27 +/- 24 pg. ml(-1) vs 20 +/- 18 pg. ml(-1)), determined in venous blood using immunoradiometric assays were elevated but remained unalt ered following recompensation. Brachial artery diameter, derived from high-resolution ultrasound scans at rest and during reactive hyperaemi a, 90 s after forearm cuff deflation, increased significantly during r eactive hyperaemia at the time of admission (34 +/- 0.7 mm vs 4.0 +/- 0.5 mm; P=0.014) and following recompensation (3.4 +/- 0.5 mm vs 3.8 /- 0.2 mm; P=0.032). The brachial artery diameter during recompensatio n expressed as a percentage of the baseline value was similar at both intervals (decompensation vs recompensation: 117 +/- 14% vs 116+/-10%; P=ns). At the time of decompensation, the correlation between TNF-alp ha and the percentage change in brachial artery diameter following rea ctive hyperaemia was absent (r=0.098; P=0.719). The same correlation b ecame significant at the time of recompensation (r=0.750; P=0.001). Co nclusions In patients with congestive heart failure, plasma levels of pro-inflammatory cytokines correlate with endothelium-dependent vasodi lation of the brachial artery following recompensation, but not during an acute episode of heart failure.