|
|
||||||||||
|
J Am Coll Cardiol, 2000; 36:523-528 © 2000 by the American College of Cardiology Foundation |



* Department of Cardiac Medicine, National Heart & Lung Institute, Imperial College School of Medicine, London, United Kingdom
Department of Medicine, Veterans Administration Medical Center, Baylor College of Medicine, Houston, Texas, USA
Franz-Volhard-Klinik (Charité, Campus Berlin-Buch) at Max-Delbrück-Centrum for Molecular Medicine, Berlin, Germany
Department of Internal Medicine III, Martin-Luther University, Halle, Germany
Manuscript received October 20, 1999; revised manuscript received February 1, 2000, accepted March 30, 2000.
Reprint requests and correspondence: Dr. Stefan Anker, Cardiac Medicine, NHLI London, Dovehouse Street, London SW3 6LY, United Kingdom
s.anker{at}ic.ac.uk
OBJECTIVES
The object of the study was to assess the relationship between erythrocyte sedimentation rate (ESR) and inflammatory cytokine production in chronic heart failure (CHF). Our findings lead us to re-evaluate the prognostic value of the ESR in assessing patients with CHF.
BACKGROUND
The search for simple prognostic markers in CHF that can be assessed anywhere at low cost is important. Increases in ESR are related to the acute phase response in states of inflammation and infection.
METHODS
Initially, we studied ESR in relation to plasma levels of inflammatory cytokines in 58 CHF patients. The findings prompted us to analyze the mortality predictive power of ESR compared with established risk factors in these patients and (retrospectively) in a second group of 101 clinically stable CHF patients who had ESR measured.
RESULTS
In all 159 CHF patients (age 62 ± 2 years, New York Heart Association [NYHA] class 2.7 ± 0.1), ESR ranged from 1 to 96 mm/h (median 14 mm/h). The ESR was correlated with tumor necrosis factor (TNF)-alpha (r = 0.31, p < 0.05), soluble TNF receptor-1 (r = 0.48, p < 0.0005), soluble TNF receptor-2 (r = 0.39, p < 0.005) and interleukin 6 (r = 0.45, p < 0.005) levels. High ESR levels indicated a poor prognosis (p < 0.0001), and this was independent of age, NYHA class, ejection fraction and peak oxygen consumption (p < 0.005). Patients with ESR above median (
15 mm/h) compared with patients with ESR <15 mm/h had an impaired survival (hazard ratio 2.62, 95% confidence interval 1.584.36, p < 0.0001).
CONCLUSIONS
Our study demonstrates that in CHF a high ESR is an unfavorable prognostic sign, independent of patients symptomatology and ventricular function. These results are in diametrical contrast to previous results. This may reflect a change in the underlying pathophysiology due to todays treatment with angiotensin-converting enzyme inhibitors.
| ||||||||||||||||||||||||
This article has been cited by other articles:
![]() |
H Maradit-Kremers, P J Nicola, C S Crowson, K V Ballman, S J Jacobsen, V L Roger, and S E Gabriel Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis Ann Rheum Dis, January 1, 2007; 66(1): 76 - 80. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Ingelsson, J. Arnlov, J. Sundstrom, and L. Lind Inflammation, as Measured by the Erythrocyte Sedimentation Rate, Is an Independent Predictor for the Development of Heart Failure J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1802 - 1806. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. D'Aloia, P. Faggiano, G. Aurigemma, L. Bontempi, G. Ruggeri, M. Metra, S. Nodari, and L. Dei Cas Serum levels of carbohydrate antigen 125 in patients with chronic heart failure: Relation to clinical severity, hemodynamic and Doppler echocardiographic abnormalities, and short-term prognosis J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1805 - 1811. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. D. Anker, W. Doehner, M. Rauchhaus, R. Sharma, D. Francis, C. Knosalla, C. H. Davos, M. Cicoira, W. Shamim, M. Kemp, et al. Uric Acid and Survival in Chronic Heart Failure: Validation and Application in Metabolic, Functional, and Hemodynamic Staging Circulation, April 22, 2003; 107(15): 1991 - 1997. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Malhotra, V. V. Muse, and E. J. Mark Case 12-2003 - An 82-Year-Old Man with Dyspnea and Pulmonary Abnormalities N. Engl. J. Med., April 17, 2003; 348(16): 1574 - 1585. [Full Text] [PDF] |
||||
![]() |
R Sharma, V G Florea, A P Bolger, W Doehner, N D Florea, A J S Coats, M E Hodson, S D Anker, and M Y Henein Wasting as an independent predictor of mortality in patients with cystic fibrosis Thorax, October 1, 2001; 56(10): 746 - 750. [Abstract] [Full Text] [PDF] |
||||
![]() |
H.J. Koch and C. Raschka Over-training syndrome as a model of a coronary inflammation process? Eur. Heart J., August 2, 2001; 22(16): 1512 - 1512. [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |