title: [Prognostic value of serum levels of tumor necrosis factor-alpha in patients with heart failure].
abstract: OBJECTIVE
  Tumor necrosis factor-alpha is an inflammatory cytokine which rises in heart failure and has prognostic value in severe cases. Its value is less established in moderate cases. Our aim was to determine its prognostic value in cases from a community hospital.
  
  
  METHODS
  We studied 50 patients, average age 59.5 12.3 years, with dilated cardiomyopathy (72% non-ischemic) and moderate heart failure (59% functional class II).
  
  
  METHODS
  Patients were evaluated with an echocardiogram and cardiopulmonary treadmill stress test (Naughton), muscular strength measurements (hand dynamometer), blood tumor necrosis factor levels, and an average follow-up of 17.5 9 months (range, 1-29 months). All causes of mortality, cardiac transplantation, and readmissions for heart failure were recorded.
  
  
  RESULTS
  Twenty-three patients experienced events. These patients were older (63 +/- 12.7 vs 55.7 +/- 11.4 years; p = 0.042), had a lower peak VO2 (13.7 +/- 3.9 vs 16 +/- 3.3 ml/kg/min; p = 0.035), and higher peak VE/VCO2 and factor levels [41.9 +/- 10.6 vs 33.2 +/- 5.7; p = 0.001 and 4.3 (3.1-7.9) vs 3.3 (2.4-4.3) pg/ml; p = 0.021, respectively]. In the Cox model, the only variable with independent prognostic value was peak VE/VCO2 [HR 1.13 (1.07-1.19); p < 0.001]. The best cutoff point was 34.5 (sensitivity, 86.4%; specificity, 58.3%; p = 0.0007). The cytokine had no independent prognostic value.
  
  
  CONCLUSIONS
  Our patients with events were older, had a lower peak VO2, and higher peak VE/VCO2 and serum tumor necrosis factor levels. However, only peak VE/VCO2 had independent prognostic value.
authors.affiliation: Sección de Cardiología, Laboratorio de Investigación, Hospital General Universitario de Elche, Spain. ajordant@coma.es
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Jordán
authors.forename: Angel
authors.initials: A
authors.lastname: Esteban
authors.forename: Miguel
authors.initials: M
authors.lastname: García
authors.forename: José V
authors.initials: JV
authors.lastname: Monmeneu
authors.forename: Dolores
authors.initials: D
authors.lastname: Espinosa
authors.forename: Fernando
authors.initials: F
authors.lastname: Reyes
authors.forename: Juan
authors.initials: J
authors.lastname: Luján
authors.forename: Vicente
authors.initials: V
authors.lastname: Climent
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.forename: Fernando
authors.initials: F
authors.lastname: García de Burgos
mesh_terms: D015992:Body Mass Index; D004452:Echocardiography; D005080:Exercise Test / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D014409:Tumor Necrosis Factor-alpha