Tumor necrosis factor-α receptor 1 is a major predictor of mortality and new-onset heart failure in patients with acute myocardial infarction -: The cytokine-activation and long-term prognosis in myocardial infarction (C-ALPHA) study
Tumor necrosis factor-α receptor 1 is a major predictor of mortality and new-onset heart failure in patients with acute myocardial infarction -: The cytokine-activation and long-term prognosis in myocardial infarction (C-ALPHA) study
复制标题
DOI：
10.1161/01.cir.0000155614.35441.69
复制
发表时间：
2005-02-22
期刊：
影响因子：
37.8
通讯作者：
Ferrari, R
中科院分区：
文献类型：
--
作者：
Valgimigli, M;Ceconi, C;Ferrari, R
背景-肿瘤坏死因子α-α(TNF-α)活化是心力衰竭(HF)患者死亡率的独立预后指标。方法与结果：我们对连续入院的心肌梗死患者(男132例，平均年龄+/-12岁)进行了肿瘤坏死因子及其1型和2型可溶性受体、白细胞介素6、白细胞介素1受体拮抗剂和白细胞介素10的系统评估。我们将它们的值与死亡和心力衰竭(主要结局)的短期和长期发生率相关联。在10名患者中，我们还研究了经心脏梯度的肿瘤坏死因子-α及其可溶性受体的存在。对照组包括45名与患者性别和年龄匹配的健康受试者(33名男性，平均年龄65+/-6岁)。所有受试细胞因子在患者体内均升高，且未发现经心脏或全身房室传导速度的差异。中位随访时间为406天(范围为346至696天)，24名患者死亡，32名患者发展为心衰。单因素分析显示，所有细胞因子与预后相关，而在调整基线和临床特征后，sTNFR-1仍然是唯一独立的死亡和心力衰竭预测因子(风险比，2.9；95%CI，1.9~3.8，三分之1比3)，以及左心室射血分数、Killip分级和肌酸激酶MB峰值。结论：sTNFR-1是急性心肌梗死患者死亡率和心力衰竭的主要短期和长期预测因子。
Background - Tumor necrosis factor alpha-alpha (TNF-alpha) activation is an independent prognostic indicator of mortality in patients with heart failure (HF). Despite the recognition that several TNF family cytokines are elevated during myocardial infarction, their role in predicting subsequent prognosis in these setting remains poorly understood.Methods and Results - We performed a systematic evaluation of TNF-alpha and its type 1 and 2 soluble receptors, together with interleukin (IL)-6, IL-1 receptor antagonist, and IL-10, in 184 patients (132 men; mean age, 64 +/- 12) consecutively admitted for myocardial infarction. We correlated their values to short- and long-term incidence of death and HF (primary outcome). In 10 patients, we also studied the presence of transcardiac gradients for TNF-alpha and its soluble receptors. The control group comprised 45 healthy subjects who were sex and age matched (33 men; mean age, 65 +/- 6 years) to the patients. All tested cytokines were increased in patients, and no transcardiac or systemic AV difference was found. After a median follow-up of 406 days (range, 346 to 696 days), 24 patients died and 32 developed HF. Univariate analysis showed that all cytokines were related to outcome, whereas after adjustment for baseline and clinical characteristics, sTNFR-1 remained the only independent predictor of death and HF (hazard ratio, 2.9; 95% CI, 1.9 to 3.8, tertile 1 versus 3), together with left ventricular ejection fraction, Killip class, and creatine kinase-MB at peak.Conclusions - sTNFR-1 is a major short- and long-term predictor of mortality and HF in patients with acute myocardial infarction.