作者: Mathias Rauchhaus , Wolfram Doehner , Darrel P. Francis , Constantinos Davos , Michael Kemp
DOI: 10.1161/01.CIR.102.25.3060
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摘要: BACKGROUND: Inflammatory immune activation is an important feature in chronic heart failure (CHF). Little known about the prognostic importance of tumor necrosis factor-alpha (TNF-alpha), soluble TNF-receptor 1 and 2 (sTNF-R1/sTNF-R2), interleukin-6 (IL-6), CD14 receptors (sCD14) CHF patients. METHODS AND RESULTS: In 152 patients (age 61+/-1 years, New York Heart Association [NYHA] class 2.6+/-0.1, peak VO(2) 17.3+/-0.6 mL. kg(-1). min(-1), mean+/-SEM) plasma concentrations variables were prospectively assessed. During a mean follow-up 34 months (>12 all patients), 62 (41%) died. Cumulative mortality was 28% at 24 months. univariate analyses, increased total trimeric TNF-alpha, sTNF-R1, sTNF-R2 (all P=0.0001), sCD14 (P=0.0007), IL-6 (P=0.005) predicted 24-month mortality. With multivariate analysis receiver operating characteristics, sTNF-R1 emerged among cytokine parameters as strongest most accurate prognosticator this population, regardless duration independently NYHA class, VO(2), VE/VCO(2) slope, left ventricular ejection fraction, wasting (P<0.001). The characteristic area under curve for greater than 6, 12, 18 P<0.05). CONCLUSIONS: prognosticator, independent established markers severity. Assessment may be useful identifying who are high risk death monitoring undergoing anti-TNF-alpha treatment.