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Do cytokines enable risk stratification to be improved in NYHA functional class III patients? Comparison with other
R Kell1, A Haunstetter, T J Dengler
1Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
Insights
Interleukin-6 levels predict long-term survival in heart failure patients. This cytokine marker, combined with ejection fraction and peak VO2, enhances risk stratification for heart failure prognosis.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Elevated proinflammatory cytokines are observed in heart failure.
- Accurate risk stratification is crucial for managing heart failure patients.
Purpose of the Study:
- To evaluate the role of cytokines in risk stratification.
- Focus on New York Heart Association (NYHA) class III patients with left ventricular ejection fraction <40%.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) measured cytokine levels.
- Analyzed 91 NYHA class III heart failure patients.
- Follow-up for cardiovascular mortality over 22 months.
Main Results:
- Interleukin-6 (IL-6) levels were significantly higher in non-survivors compared to survivors.
- IL-6 demonstrated independent prognostic power for long-term survival (>1 year).
- Combining IL-6 with ejection fraction and peak oxygen uptake improved risk prediction.
Conclusions:
- Plasma IL-6 concentrations predict long-term survival in NYHA class III heart failure.
- IL-6's utility for short-term risk stratification, like for cardiac transplantation, is limited.
Aims:
Elevated plasma levels of proinflammatory cytokines have been reported in patients with congestive heart failure. The purpose of this study was to assess whether cytokines improve risk stratification in a homogeneous group of NYHA class III patients with a left ventricular ejection fraction <40%.
Methods And Results:
Plasma concentrations of big endothelin, tumour necrosis factor alpha, interleukins -1, -6, -10 and -12, sCD14 and GM-CSF were measured by ELISA in 91 NYHA III patients [mean (SD) age: 55 (10) years, 69% male, 34% coronary artery disease, 66% dilated cardiomyopathy] with a left ventricular ejection fraction and a peak oxygen uptake (peak VO2) of 19 (9)% and 12.1 (3.6) ml x min(-1) x kg(-1), respectively. During follow-up [22 (13) months], 31 patients (34%) died due to cardiovascular causes. In non-survivors, interleukin-6 was twice as high as in survivors [12.8 (16.9) pg x ml(-1)vs 5.6(5.3) pg x ml(-1), P<0.003], whereas plasma concentrations of the other cytokines showed no significant differences. Concerning long-term survival (> or =1 year), multivariate Cox regression analysis revealed an independent prognostic power for interleukin-6, which was further improved by combining with left ventricular ejection fraction and peak VO2, while for short-term survival (up to 6 months) interleukin-6 did not allow risk stratification.
Conclusion:
In NYHA class III patients, plasma concentrations of interleukin-6 are predictive of long-term survival. However, its value may be limited for clinical decision-making for cardiac transplantation (short-term survival).
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