Tumor necrosis factor-alpha and mortality in heart failure: a community study.
BACKGROUND
Tumor necrosis factor-alpha (TNFalpha), an inflammatory cytokine, was reported to be elevated in trials of heart failure (HF) with reduced ejection fraction (EF) and associated with mortality. Whether this is true for HF with preserved EF is unknown, and community data are lacking. We evaluated the distribution of TNFalpha, its association with baseline characteristics and mortality, and its benefit in assessing risk in community HF patients.


RESULTS
Olmsted County residents with active HF from July 2004 to March 2007 (n=486; mean age, 76.7 years; EF > or =50%, 55%) were prospectively recruited. Clinical characteristics and TNFalpha were measured. Elevated TNFalpha (more than the assay limit of normal of 2.8 pg/mL) was present in 143 (29%). Higher TNFalpha was associated with decreased creatinine clearance, nonsmoking status, anemia, and greater comorbidity (P(trend)<0.05 for all). Mortality increased with increasing TNFalpha (P=0.016), with 1-year mortality estimates of 16%, 18%, 23%, and 32% from the lowest to highest quartile, respectively. After adjustment for age, sex, and EF, the hazard ratios for death were 1.24, 1.37, and 1.90 from the second to the highest TNFalpha quartile, respectively (P(trend)=0.007). TNFalpha contributed to risk assessment as indicated by increases in the area under the receiver operating characteristic curves in all models examined (P<0.05 for all). Results did not differ by EF (P=0.60 interaction term of TNFalpha and EF).


CONCLUSIONS
TNFalpha was elevated in a large portion of community HF patients, was associated with a large decrease in survival, and provided a significant incremental increase in risk assessment above established indicators. TNFalpha is useful for risk assessment in HF patients with preserved and reduced EF.
Dunlay
Shannon M
SM
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minn., USA.
Weston
Susan A
SA
Redfield
Margaret M
MM
Killian
Jill M
JM
Roger
Véronique L
VL
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood* / Q000276:immunology
D014409:Tumor Necrosis Factor-alpha