Endothelial function and proinflammatory cytokines in patients with ischemic heart disease and dilated cardiomyopathy

Background: Proinflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) are important mediators of immune response, associated with endothelial dysfunction in patients with coronary artery disease (CAD) or heart failure. We compared endothelial function and levels of IL-6 and TNF-a between patients with ischemic heart failure, dilated cardiomyopathy, CAD and healthy controls. Methods: The population consisted of 20 patients with dilated cardiomyopathy, 48 patients with ischemic cardiomyopathy, 26 patients with CAD and normal left ventricle function and 14 healthy controls. Forearm blood flow was measured using venous occlusion strain gauge plethysmography. Forearm vasodilatory response to reactive hyperemia (RH%) or to nitrate were considered as indexes of endothelium-dependent and endothelium-independent dilation, respectively. Results: Levels of IL-6 were significantly higher in ischemic cardiomyopathy compared to CAD patients (P < 0.05) or controls (P < 0.05) and in patients with dilated cardiomyopathy compared to controls (P < 0.05). TNF-alpha levels were significantly higher in both groups with ischemic or dilated cardiomyopathy compared to CAD (P < 0.05) or controls (P < 0.05). RH% was significantly lower in ischemic and dilated cardiomyopatby compared to CAD (P < 0.05) or controls (P < 0.001) and higher in dilated than ischemic cardiomyopathy (P < 0.05). Conclusions: Impaired endothelial function and increased inflammatory process were found in both types of heart failure. A greater endothelial dysfunction was observed in patients with ischemic heart failure compared to those with dilated cardiomyopathy, implying that the underlying atherosclerosis may participate in this process. (C) 2004 Elsevier Ireland Ltd. All rights reserved.