Monocyte activation in congestive heart failure due to coronary artery disease and idiopathic dilated cardiomyopathy

Objective: To investigate plasma tumor necrosis factor (TNF)α, tumor necrosis factor α soluble receptor I, interleukin-1β and neopterin concentrations as markers of monocyte activation in patients with heart failure. Study design: The group consisted of patients with heart failure due to dilated cardiomyopathy (n=19) and coronary artery disease (n=11). Patients without cardiac failure served as controls (n=10). Results: TNFα concentrations were elevated only in heart failure patients with coronary artery disease (2.9±0.3 pg/ml versus 1.7±0.3 pg/ml; P<0.05). When the patients were grouped according to acute and chronic failure, TNFα concentrations were significantly elevated in acute failure (3.1±0.4 pg/ml, n=6 versus 1.7±0.2 pg/ml, n=8; P<0.05). TNFα concentrations were elevated in patients with coronary artery disease and chronic heart failure compared to coronary artery disease patients without failure (2.0±0.4 pg/ml, n=6 versus 1.8±0.3 pg/ml, n=7; P<0.05). A higher proportion of patients with myocardial insufficiency showed increased lipopolysaccharide–inducible TNFα concentrations (10/30 versus 0/9, P<0.05). Conclusions: TNFα is elevated in patients with acute cardiac decompensation. Among patients with chronic heart failure only those with coronary artery disease exhibit increased levels. Cytokine concentrations are similar in heart failure due to dilated cardiomyopathy and coronary artery disease. Monocytes of patients suffering from cardiac insufficiency show an increased sensitivity towards stimuli such as lipopolysaccharides.