title: Tumor necrosis factor-α predicts response to cardiac resynchronization therapy in patients with chronic heart failure.
abstract: BACKGROUND
  Pro-inflammatory cytokines contribute to the pathophysiology of heart failure (HF) and are up-regulated in affected patients. We investigated whether pro-inflammatory cytokines might predict the response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Plasma levels of tumor necrosis factor-α (TNF-α) and interleukin-6 were assessed in 91 patients before CRT. Response to CRT was defined as a decrease ≥15% in left ventricular end-systolic volume (LVESV) at 6 months. Baseline TNF-α did correlate with LVESV reduction (P=0.001) after CRT. The subject group was divided according to tertiles of TNF-α. From the lower to the upper tertile LVESV (-31±28%, -17±17%, -9±22%) and LV end-diastolic volume (-23±25%, -14±16%, -4±18%) were progressively less reduced after CRT (P<0.001). The proportion of responders to CRT was 70%, 42% and 33%, according to the lower, intermediate and upper tertile of TNF-α distribution (P=0.01). Serious cardiac events (cardiac death, HF hospitalization or urgent heart transplantation) occurred in 63% of patients in the upper tertile vs. 32% and 17% in the intermediate and lower tertiles, respectively, during a median follow-up of 47 months (P<0.001).
  
  
  CONCLUSIONS
  Circulating TNF-α predicts the degree of LV reverse remodeling after CRT and may contribute to the early identification of those patients at higher risk of events after device implantation.
authors: Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo.
authors: Roberto
authors: R
authors: Rordorf
authors: Simone
authors: S
authors: Savastano
authors: Antonio
authors: A
authors: Sanzo
authors: Carla
authors: C
authors: Spazzolini
authors: Mara
authors: M
authors: De Amici
authors: Rita
authors: R
authors: Camporotondo
authors: Stefano
authors: S
authors: Ghio
authors: Alessandro
authors: A
authors: Vicentini
authors: Barbara
authors: B
authors: Petracci
authors: Valentina
authors: V
authors: De Regibus
authors: Erika
authors: E
authors: Taravelli
authors: Maurizio
authors: M
authors: Landolina
authors: Peter J
authors: PJ
authors: Schwartz
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D002908:Chronic Disease; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D020257:Ventricular Remodeling
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha