Inflammatory markers in stable heart failure and their relationship with functional class☆

Abstract 

Introduction and objectives

While it appears to be clear that an inflammatory process occurs in heart failure (HF), it is still to be defined whether inflammation depends to a greater extent on HF etiology, functional class (FC), or the extent of depression of ejection fraction (EF). Our objectives were to analyze differences in inflammatory marker levels as compared to a healthy population, to assess differences depending on HF etiology, and to relate values with FC and EF.

Patients and methods

Fifty-nine consecutive outpatients with stable HF (57+/−9 years, 89% males) and 59 controls (55+/−8 years, 85% males) were enrolled into the study. Causes of HF included ischemic heart disease (n=24), idiopathic dilated cardiomyopathy (n=24), and miscellaneous conditions (n=11). Patients with decompensation in the past 6 months were excluded from the study. Protein fibrinogen, sialic acid, C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-alpha) were measured. Echocardiography was performed in all study patients. FC was assessed using the NYHA classification.

Results

A comparison of inflammatory marker levels between the HF and control groups showed significant differences in all markers, except for TNF-alpha. Protein fibrinogen in controls: 253+/−54 mg/dl, protein fibrinogen in HF: 294+/−67 mg/dl; p<0.05. Sialic acid in controls: 53+/−1 mg/dl, sialic acid in HF: 61+/−12 mg/dl; p<0.05. CRP in controls: 1.3+/−0.7 mg/dl, CRP in HF: 7.8+/−1.2 mg/dl; p<0.05. TNF-alpha in controls: 183+/−51 ng/ml, TNF-alpha in HF: 203+/−13 ng/ml; p=0.2. No differences were found between the different etiologies of HF. A positive association was seen between FC and protein fibrinogen and TNF-alpha (p<0.05), but not with EF.

Conclusions

Increased inflammatory marker levels related to FC of the patient, but not to EF, are found in chronic HF.

Keywords: Heart failure, Inflammatory markers, Ventricular function, Functional class