Effect ol losartan on circulating TNF alpha levels and left ventricular systolic performance in patients with heart failure

Background Tumor necrosis factor alpha (TNF alpha) plays an important role in the pathophysiology of heart failure. Recent studies have shown a benefi cial effect of losartan in these patients. However, the effect of losartan on TNF alpha levels in heart failure has not yet been studied. We evaluated the effect of losartan on circulating TNF alpha levels and ejection fracti on (EF) in patients with congestive heart failure. Methods Forty patients with heart failure and EF less than or equal to 40% were enrolled into the study. All of the patients have been given diuretic and digitalis therapy. Twenty patients were given losartan (50 mg/d) (Group I, 10 women, 10 men, 12 dilated cardiomyopathy, 8 ischemic heart disease, mean age 64.9 +/- 8.9), and another 20 patients were not given losartan bec ause of hypotension or renal dysfunction (Group II, 13 men, 7 women, 10 dil ated cardiomyopathy, 10 ischemic heart disease, mean age 61.2 +/- 10.5). EF was measured at the initial evaluation and on the fifteenth day of the the rapy by echocardiographic examination using an acoustic quantification meth od. Circulating TNF alpha levels were also measured at the initial evaluati on and on the fifteenth day of therapy by the ELISA method. Results Losartan significantly increased EF and decreased TNF alpha (EF inc reased from 29.4 +/- 7.3% to 36.0 +/- 8.5%, P < 0.001, and TNF alpha decrea sed from 39.2 +/- 37.4 pg/ml to 27.0 +/- 30.0 pg/ml, P < 0.05). Changes in TNF alpha levels and EF were not found to be correlated (r=-0.28, P=0.24). However, in the control group, EF and TNF alpha levels were similar at base line and at the fifteenth day (EF 31.4 +/- 8.1% vs 31.7 +/- 7.8%, P=0.1, an d TNF alpha 91.5 +/- 86.0 pg/ml vs 110.0 +/- 80.7 pg/ml, P=0.1, respectivel y). Conclusions Losartan improves left ventricular systolic function and decrea ses TNF alpha level. The decreased TNF alpha level seems to be independent of EF. (C) 2001 Lippincott Williams & Wilkins.