TNF-α Predicts Endothelial Function and Number of CD34+ Cells after Stimulation with G-CSF in Patients with Advanced Heart Failure

Patients with advanced heart failure (HF) have reduced cardiac output and impaired peripheral blood flow, which diminishes endothelial shear stress and consequently flow-mediated dilatation (FMD). The aim of our study was to find out whether endothelial dysfunction is associated with the number of CD34(+) cells and TNF-alpha levels in patients with ischemic and non-ischemic HF after stimulation with granulocyte colony-stimulating factor (G-CSF). We included 56 patients with advanced HF (LVEF < 35%). Eighteen patients (32.14%) had ischemic and 38 (67.86%) patients had non-ischemic HF. FMD of the brachial artery was performed before the patients underwent 5-day bone marrow stimulation with daily subcutaneous injections of G-CSF (5 mu g/kg bid). On the fifth day peripheral blood CD34(+) cell count was measured. No statistically significant differences were found between the patient groups in NT-proBNP levels ((1575 (425-2439) vs. 1273 (225-2239)) pg/mL; p = 0.40), peripheral blood CD34(+) cell count ((67.54 +/- 102.32 vs. 89.76 +/- 71.21) x 10(6) ; p = 0.32), TNF-alpha ((8.72 +/- 10.30 vs. 4.96 +/- 6.16) ng/mL; p = 0.13) and FMD (6.7 +/- 5.4 vs. 7.2 +/- 5.9%; p = 0.76). In a linear regression model, only FMD (p = 0.001) and TNF-alpha (p = 0.003) emerged as statistically significant predictors of CD34(+) cells counts. Our study suggests that TNF-alpha is a good predictor of impaired endothelial function and of CD34(+) cells mobilization after G-CSF stimulation in patients with advanced HF of ischemic and non-ischemic origin.