Elevated circulating levels of tumor necrosis factor in severe chronic heart failure

Beth Levine, Jill Kalman, Lloyd Mayer, Howard M. Fillit, Milton Packer

Research output: Contribution to journalArticle

1998 Citations (Scopus)

Abstract

Background and Methods. Although cachexia often accompanies advanced heart failure, little is known about the causes of the cachectic state. To assess the potential role of tumor necrosis factor in the pathogenesis of cardiac cachexia, we measured serum levels of the factor in 33 patients with chronic heart failure, 33 age-matched healthy controls, and 9 patients with chronic renal failure. Results. Mean (±SEM) serum levels of tumor necrosis factor were higher in the patients with heart failure (115±25 U per milliliter) than in the healthy controls (9±3 U per milliliter; P<0.001). Nineteen of the patients with chronic heart failure had serum levels of tumor necrosis factor ≥39 U per milliliter (>2 SD above the mean value for the control group), whereas the remaining 14 patients had serum levels of tumor necrosis factor below this level. The patients with high levels of tumor necrosis factor were more cachectic than those with low levels (82±3 vs. 95±6 percent of ideal body weight, respectively; P<0.05) and had more advanced heart failure, as evidenced by their higher values for plasma renin activity (2.92±0.53 vs. 1.06±0.53 ng per liter per second [10.5±1.9 vs. 3.8±1.9 ng per milliliter per hour]; P<0.01) and lower serum sodium concentration (135±1 vs. 138±1 mmol per liter; P<0.05). The group with high levels of tumor necrosis factor also had lower hemoglobin levels (7.82±0.2 vs. 8.69±0.4 mmol per liter [12.6±0.4 vs. 14.0±0.6 g per deciliter]) and higher values for blood urea nitrogen (19.5±2.2 vs. 12.5±1.8 mmol per liter) than the group with low levels of tumor necrosis factor (P<0.05 for both). The high levels of tumor necrosis factor were not due solely to decreased renal clearance, however, since the levels in the patients with heart failure were considerably higher than those in the nine patients with chronic renal failure (115±25 vs. 45±25 U per milliliter; P<0.05). Conclusions. These findings indicate that circulating levels of tumor necrosis factor are increased in cachectic patients with chronic heart failure and that this elevation is associated with the marked activation of the renin-angiotensin system seen in patients with end-stage cardiac disease.

Original languageEnglish (US)
Pages (from-to)236-241
Number of pages6
JournalNew England Journal of Medicine
Volume323
Issue number4
StatePublished - Jul 26 1990

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Heart Failure
Tumor Necrosis Factor-alpha
Cachexia
Serum
Chronic Kidney Failure
Ideal Body Weight
Blood Urea Nitrogen
Renin-Angiotensin System
Renin
Heart Diseases
Hemoglobins
Sodium
Kidney
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. / Levine, Beth; Kalman, Jill; Mayer, Lloyd; Fillit, Howard M.; Packer, Milton.

In: New England Journal of Medicine, Vol. 323, No. 4, 26.07.1990, p. 236-241.

Research output: Contribution to journalArticle

Levine, B, Kalman, J, Mayer, L, Fillit, HM & Packer, M 1990, 'Elevated circulating levels of tumor necrosis factor in severe chronic heart failure', New England Journal of Medicine, vol. 323, no. 4, pp. 236-241.
Levine, Beth ; Kalman, Jill ; Mayer, Lloyd ; Fillit, Howard M. ; Packer, Milton. / Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. In: New England Journal of Medicine. 1990 ; Vol. 323, No. 4. pp. 236-241.
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abstract = "Background and Methods. Although cachexia often accompanies advanced heart failure, little is known about the causes of the cachectic state. To assess the potential role of tumor necrosis factor in the pathogenesis of cardiac cachexia, we measured serum levels of the factor in 33 patients with chronic heart failure, 33 age-matched healthy controls, and 9 patients with chronic renal failure. Results. Mean (±SEM) serum levels of tumor necrosis factor were higher in the patients with heart failure (115±25 U per milliliter) than in the healthy controls (9±3 U per milliliter; P<0.001). Nineteen of the patients with chronic heart failure had serum levels of tumor necrosis factor ≥39 U per milliliter (>2 SD above the mean value for the control group), whereas the remaining 14 patients had serum levels of tumor necrosis factor below this level. The patients with high levels of tumor necrosis factor were more cachectic than those with low levels (82±3 vs. 95±6 percent of ideal body weight, respectively; P<0.05) and had more advanced heart failure, as evidenced by their higher values for plasma renin activity (2.92±0.53 vs. 1.06±0.53 ng per liter per second [10.5±1.9 vs. 3.8±1.9 ng per milliliter per hour]; P<0.01) and lower serum sodium concentration (135±1 vs. 138±1 mmol per liter; P<0.05). The group with high levels of tumor necrosis factor also had lower hemoglobin levels (7.82±0.2 vs. 8.69±0.4 mmol per liter [12.6±0.4 vs. 14.0±0.6 g per deciliter]) and higher values for blood urea nitrogen (19.5±2.2 vs. 12.5±1.8 mmol per liter) than the group with low levels of tumor necrosis factor (P<0.05 for both). The high levels of tumor necrosis factor were not due solely to decreased renal clearance, however, since the levels in the patients with heart failure were considerably higher than those in the nine patients with chronic renal failure (115±25 vs. 45±25 U per milliliter; P<0.05). Conclusions. These findings indicate that circulating levels of tumor necrosis factor are increased in cachectic patients with chronic heart failure and that this elevation is associated with the marked activation of the renin-angiotensin system seen in patients with end-stage cardiac disease.",
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N2 - Background and Methods. Although cachexia often accompanies advanced heart failure, little is known about the causes of the cachectic state. To assess the potential role of tumor necrosis factor in the pathogenesis of cardiac cachexia, we measured serum levels of the factor in 33 patients with chronic heart failure, 33 age-matched healthy controls, and 9 patients with chronic renal failure. Results. Mean (±SEM) serum levels of tumor necrosis factor were higher in the patients with heart failure (115±25 U per milliliter) than in the healthy controls (9±3 U per milliliter; P<0.001). Nineteen of the patients with chronic heart failure had serum levels of tumor necrosis factor ≥39 U per milliliter (>2 SD above the mean value for the control group), whereas the remaining 14 patients had serum levels of tumor necrosis factor below this level. The patients with high levels of tumor necrosis factor were more cachectic than those with low levels (82±3 vs. 95±6 percent of ideal body weight, respectively; P<0.05) and had more advanced heart failure, as evidenced by their higher values for plasma renin activity (2.92±0.53 vs. 1.06±0.53 ng per liter per second [10.5±1.9 vs. 3.8±1.9 ng per milliliter per hour]; P<0.01) and lower serum sodium concentration (135±1 vs. 138±1 mmol per liter; P<0.05). The group with high levels of tumor necrosis factor also had lower hemoglobin levels (7.82±0.2 vs. 8.69±0.4 mmol per liter [12.6±0.4 vs. 14.0±0.6 g per deciliter]) and higher values for blood urea nitrogen (19.5±2.2 vs. 12.5±1.8 mmol per liter) than the group with low levels of tumor necrosis factor (P<0.05 for both). The high levels of tumor necrosis factor were not due solely to decreased renal clearance, however, since the levels in the patients with heart failure were considerably higher than those in the nine patients with chronic renal failure (115±25 vs. 45±25 U per milliliter; P<0.05). Conclusions. These findings indicate that circulating levels of tumor necrosis factor are increased in cachectic patients with chronic heart failure and that this elevation is associated with the marked activation of the renin-angiotensin system seen in patients with end-stage cardiac disease.

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