Inflammation and endothelial dysfunction in patients with chronic heart failure

Background: In chronic heart failure (CHF), endothelial dysfunction (ED) is a consequence of an imbalance of vascular tone regulating substances. The relationship between ED and inflammation has not been fully investigated. Aim: To assess the association between inflammation and ED in CHF. Material and methods: Forty two patients aged 56 +/- 14 years (80% male) with a CHF in functional capacity II-III (New York Heart Association) and an ejection fraction (EF) < 40% were consecutively studied. Patients were classified according to the presence or absence of ED, evaluated by reactive vasodilation measured by ultrasound, after brachial artery compression. Circulating levels of highly sensitive C reactive protein (usCRP), tumor necrosis factor alpha (TNF alpha) and interleukin-6 (IL-6) were determined by ELISA. A group of 15 healthy subjects of similar age, were studied as controls. Results: Sixty seven percent of patients had ED. Compared to controls, patients with CHF had higher usCRP (0.58 +/- 0.4 and 4.9 +/- 7.1 mg/dl respectively, p < 0.01) and IL-6 (1.38 +/- 0.06 and 3.1 +/- 1.7 mg/dl respectively, p < 0.01). Compared to patients without ED, patients with CHF and ED had higher levels of usCRP (3.0 +/- 0.4 and 6.0 +/- 5.7 mg/dl respectively, p < 0.01) and TNF alpha (0.31 +/- 0.26 and 1.0 +/- 1.1 pg/ml, p =0.02). No differences in IL-6 were found between CHF groups. Conclusions: In CHF patients, the presence of ED was associated with increased levels of inflammatory markers.