title: Inflammatory mediators in chronic heart failure in North India.
abstract: BACKGROUND
  Recent evidence shows that pro-inflammatory cytokines may be important in the assessment of severity and prognosis in congestive heart failure (CHF). In the present study, we examine the association of cytokines with causes, grade and prognosis of CHF patients.
  
  
  METHODS
  Of 127 patients with CHF, 11 were excluded and the remaining 116 patients with different aetiologies of CHF, and 250 age- and sex-matched control subjects, were evaluated in this case study. Severity of disease based on the New York Heart Association (NYHA) standards, fell within functional classes II to IV. The diagnosis of HF was based on clinical manifestations as well as on echocardiographic heart enlargement. Cytokines were measured by chemiluminescence. Causes of death were assessed based on death certificates. Multivariate logistic regression analysis was used to determine the risk factors of heart failure.
  
  
  RESULTS
  Echocardiographic ejection fraction was 39.1 +/- 8.2% (mean +/- SD) in the study group indicating class II-IV heart failure. Laboratory data showed increase in biomarkers of oxidative stress, among HF patients compared to healthy subjects. Pro-inflammatory cytokines; IL-6 and TNF-alpha were significantly higher among HF patients compared to healthy subjects. TNF-alpha and IL-6, showed significant increase among patients with CHF due to ischaemic heart disease and cardiomyopathy compared to levels among CHF patients with valvular heart disease and hypertensive heart diseases. The levels of the cytokines were significantly higher among patients with class III and IV heart failure and those who died, compared to patients with class II heart failure. Multivariate logistic regression analysis revealed that CAD, cardiomyopathy, and IL-6 were strongly associated--and low ejection fraction and TNF-alpha--weakly associated with HF. Of 116 patients, 20 (17.2%) died during a follow-up of two years, and the deaths were mainly among NYHA class III and IV patients in whom the cause of CHF was CAD (10.9%) and cardiomyopathy (6.9%) which had greater levels of cytokines.
  
  
  CONCLUSIONS
  The findings indicated that pro-inflammatory cytokines may be important indicators of causes, severity of CHF and prognosis among these patients.
authors.forename: Jan
authors.initials: J
authors.lastname: Fedacko
authors.forename: Ram B
authors.initials: RB
authors.lastname: Singh
authors.forename: Aditya
authors.initials: A
authors.lastname: Gupta
authors.forename: Krasimira
authors.initials: K
authors.lastname: Hristova
authors.forename: Eri
authors.initials: E
authors.lastname: Toda
authors.forename: Adarsh
authors.initials: A
authors.lastname: Kumar
authors.forename: Manoj
authors.initials: M
authors.lastname: Saxena
authors.forename: Anjum
authors.initials: A
authors.lastname: Baby
authors.forename: Ranjana
authors.initials: R
authors.lastname: Singh
authors.forename: Takahashi
authors.initials: T
authors.lastname: Toru
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Wilson
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007194:India; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha