PMID- 8874257
OWN - NLM
STAT- MEDLINE
DCOM- 19961120
LR  - 20220408
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 110
IP  - 4
DP  - 1996 Oct
TI  - The clinical relevance of circulating tumor necrosis factor-alpha in acute 
      decompensated chronic heart failure without cachexia.
PG  - 992-5
AB  - STUDY OBJECTIVE: To evaluate the clinical relevance of circulating tumor necrosis 
      factor-alpha (TNF alpha) in subjects with advanced acutely decompensated 
      congestive heart failure (CHF) and to determine the modulatory effect of clinical 
      interventions on short-term elaboration of this cytokine. DESIGN: Prospective, 
      case-controlled study. SETTING: Inpatient and outpatient (hospital and clinic), 
      at regional academic medical center. PATIENT INTERVENTIONS: Plasma concentrations 
      of TNF alpha were determined in 25 healthy, normal control subjects and in 29 
      noncachectic patients with advanced CHF (mean ejection fraction = 16 +/- 6%) who 
      required hospitalization for i.v. diuretic and/or inotropic therapy despite 
      optimization of oral medical regimens. CHF patients were divided into two groups: 
      diuretic responsive (group A; n = 6) and diuretic resistant requiring inotropic 
      support (group B; n = 23). Group B was randomly allocated to receive either i.v. 
      dobutamine (n = 13) or milrinone (n = 10) for 72 h. TNF alpha levels in CHF 
      patients were measured serially at baseline, at 6 h, at 48 h, at 72 h, and at 
      1-week follow-up after hospital discharge. RESULTS: Plasma TNF alpha levels at 
      baseline in CHF patients were 4.0 +/- 1.1 pg/mL (range, 0.5 to 6.5 pg/ mL) and 
      2.5 +/- 0.6 pg/mL (range, 0.5 to 6.8 pg/mL) in groups A and B, respectively, 
      which were significantly different (p < 0.002) from normal subjects (0.89 +/- 
      0.40 pg/mL; range, 0.5 to 9.7 pg/mL). Despite clinically successful therapy with 
      i.v. diuretics, dobutamine, or milrinone, plasma levels of this cytokine remained 
      unchanged. Plasma TNF alpha in CHF patients measured in recovery (1 week after 
      hospital discharge) was 5.1 +/- 1.2 pg/mL (range, 1.0 to 9.9 pg/mL) and 3.9 +/- 
      0.8 pg/mL (range, 0.5 to 8.7 pg/mL) in groups A and B, respectively. CONCLUSION: 
      These findings suggest that although noncachectic patients with chronic heart 
      failure who suffer acute decompensation elaborate significantly higher 
      circulating levels of TNF alpha compared with healthy control subjects, no 
      significant reduction or alteration in circulating TNF alpha is noted in the 
      short-term follow-up despite clinical improvement.
FAU - Milani, R V
AU  - Milani RV
AD  - Department of Internal Medicine, Ochsner Medical Institutions, New Orleans, LA, 
      USA.
FAU - Mehra, M R
AU  - Mehra MR
FAU - Endres, S
AU  - Endres S
FAU - Eigler, A
AU  - Eigler A
FAU - Cooper, E S
AU  - Cooper ES
FAU - Lavie, C J Jr
AU  - Lavie CJ Jr
FAU - Ventura, H O
AU  - Ventura HO
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Cytokines)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Cachexia
MH  - Case-Control Studies
MH  - Cytokines/blood
MH  - Female
MH  - Heart Failure/*blood/physiopathology
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Tumor Necrosis Factor-alpha/*analysis
EDAT- 1996/10/01 00:00
MHDA- 2001/03/28 10:01
CRDT- 1996/10/01 00:00
PHST- 1996/10/01 00:00 [pubmed]
PHST- 2001/03/28 10:01 [medline]
PHST- 1996/10/01 00:00 [entrez]
AID - S0012-3692(15)46495-5 [pii]
AID - 10.1378/chest.110.4.992 [doi]
PST - ppublish
SO  - Chest. 1996 Oct;110(4):992-5. doi: 10.1378/chest.110.4.992.