title: Prognostic role of myocardial tumor necrosis factor-alpha and terminal complement complex expression in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  In patients with dilated cardiomyopathy (DCM), elevated plasma levels of tumor necrosis factor-alpha (TNF-alpha) are associated with poor prognosis. The terminal complement complex (C5b-9) stimulates myocardial TNF-alpha expression.
  
  
  OBJECTIVE
  To investigate whether myocardial TNF-alpha and C5b-9 expression correlate with clinical outcome in DCM.
  
  
  RESULTS
  71 patients with DCM underwent myocardial biopsy. Biopsies were analyzed for TNF-alpha, C5b-9, markers of inflammation and for viral genome. Patients were divided into three groups according to biopsy results: group A: no TNF-alpha and no C5b-9; group B: TNF-alpha or C5b-9; and group C: TNF-alpha and C5b-9. NYHA classification, ECG and echocardiography were documented. Patients received conventional treatment of heart failure and, in a few cases, additional treatment with interferon beta(1b) (virus positive) or prednisolone (inflammatory DCM). There were 13 patients (18%) in group A, 19 patients (27%) in group B, and 39 patients (55%) in group C. All groups had a similar and significant improvement in NYHA classification and echocardiographic parameters. TNF-alpha and C5b-9 did not significantly correlate with the presence of viral genome or with markers of inflammation.
  
  
  CONCLUSIONS
  TNF-alpha and C5b-9 are widely distributed in the myocardium of DCM patients. Neither of the antigens correlates with clinical outcome. Myocardial TNF-alpha may not be a useful prognostic marker in DCM.
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany. oliver.zimmermann@medizin.ni-ulm.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Zimmermann
authors.forename: Matthias
authors.initials: M
authors.lastname: Kochs
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Zwaka
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bienek-Ziolkowski
authors.forename: Martin
authors.initials: M
authors.lastname: Höher
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Hombach
authors.forename: Jan
authors.initials: J
authors.lastname: Torzewski
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000473:pathology; D015938:Complement Membrane Attack Complex / Q000378:metabolism*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015938:Complement Membrane Attack Complex; D014409:Tumor Necrosis Factor-alpha