PMID- 10933367
OWN - NLM
STAT- MEDLINE
DCOM- 20000817
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 36
IP  - 2
DP  - 2000 Aug
TI  - The relationship of the erythrocyte sedimentation rate to inflammatory cytokines 
      and survival in patients with chronic heart failure treated with 
      angiotensin-converting enzyme inhibitors.
PG  - 523-8
AB  - OBJECTIVES: The object of the study was to assess the relationship between 
      erythrocyte sedimentation rate (ESR) and inflammatory cytokine production in 
      chronic heart failure (CHF). Our findings lead us to re-evaluate the prognostic 
      value of the ESR in assessing patients with CHF. BACKGROUND: The search for 
      simple prognostic markers in CHF that can be assessed anywhere at low cost is 
      important. Increases in ESR are related to the acute phase response in states of 
      inflammation and infection. METHODS: Initially, we studied ESR in relation to 
      plasma levels of inflammatory cytokines in 58 CHF patients. The findings prompted 
      us to analyze the mortality predictive power of ESR compared with established 
      risk factors in these patients and (retrospectively) in a second group of 101 
      clinically stable CHF patients who had ESR measured. RESULTS: In all 159 CHF 
      patients (age 62+/-2 years, New York Heart Association [NYHA] class 2.7+/-0.1), 
      ESR ranged from 1 to 96 mm/h (median 14 mm/h). The ESR was correlated with tumor 
      necrosis factor (TNF)-alpha (r = 0.31, p<0.05), soluble TNF receptor-1 (r = 0.48, 
      p<0.0005), soluble TNF receptor-2 (r = 0.39, p<0.005) and interleukin 6 (r = 
      0.45, p<0.005) levels. High ESR levels indicated a poor prognosis (p<0.0001), and 
      this was independent of age, NYHA class, ejection fraction and peak oxygen 
      consumption (p < 0.005). Patients with ESR above median (> or =15 mm/h) compared 
      with patients with ESR <15 mm/h had an impaired survival (hazard ratio 2.62, 95% 
      confidence interval 1.58-4.36, p<0.0001). CONCLUSIONS: Our study demonstrates 
      that in CHF a high ESR is an unfavorable prognostic sign, independent of 
      patients' symptomatology and ventricular function. These results are in 
      diametrical contrast to previous results. This may reflect a change in the 
      underlying pathophysiology due to today's treatment with angiotensin-converting 
      enzyme inhibitors.
FAU - Sharma, R
AU  - Sharma R
AD  - Department of Cardiac Medicine, National Heart & Lung Institute, Imperial College 
      School of Medicine, London, United Kingdom.
FAU - Rauchhaus, M
AU  - Rauchhaus M
FAU - Ponikowski, P P
AU  - Ponikowski PP
FAU - Varney, S
AU  - Varney S
FAU - Poole-Wilson, P A
AU  - Poole-Wilson PA
FAU - Mann, D L
AU  - Mann DL
FAU - Coats, A J
AU  - Coats AJ
FAU - Anker, S D
AU  - Anker SD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Cytokines)
RN  - 0 (Interleukin-6)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - *Blood Sedimentation
MH  - Cytokines/*blood
MH  - Heart Failure/*drug therapy/*mortality
MH  - Humans
MH  - Interleukin-6/blood
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Survival Analysis
MH  - Tumor Necrosis Factor-alpha/analysis
EDAT- 2000/08/10 11:00
MHDA- 2000/08/19 11:00
CRDT- 2000/08/10 11:00
PHST- 2000/08/10 11:00 [pubmed]
PHST- 2000/08/19 11:00 [medline]
PHST- 2000/08/10 11:00 [entrez]
AID - S0735-1097(00)00745-2 [pii]
AID - 10.1016/s0735-1097(00)00745-2 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2000 Aug;36(2):523-8. doi: 10.1016/s0735-1097(00)00745-2.