Pro-inflammatory cytokines and endothelium-dependent vasodilation in the forearm. Serial assessment in patients with congestive heart failure

Background In patients with heart failure endothelium-dependent vasodilationof the forearm conduit vessels is impaired possibly becauseof elevated plasma levels of pro-inflammatory cytokines. Theeffect of elevated plasma cytokines on endothelium-dependentvasodilation of forearm conduit vessels was therefore seriallyinvestigated in 16 patients with congestive heart failure duringan episode of acute failure and at the time of recompensation. Methods and Results Pro-inflammatory cytokine levels and hyperaemic brachial arterydiameters were obtained shortly after admission for an episodeof acute heart failure and 11±3 days later at the timeof recompensation, which was obtained using diuretic therapywithout changing other cardiovascular medications. Serum concentrations(Mean±SD) of tumour necrosis factor alpha (TNF-) (decompensationvs recompensation: 25±23pg.ml^–1vs 26±17pg.ml^–1)and interleukine 6 (IL-6) (decom-pensation vs recompensation:27±24pg.ml^–1vs 20±18pg.ml^–1), determinedin venous blood using immunoradiometric assays were elevatedbut remained unaltered following recompensation. Brachial arterydiameter, derived from high-resolution ultrasound scans at restand during reactive hyperaemia, 90s after forearm cuff deflation,increased significantly during reactive hyperaemia at the timeof admission (3·4±0·7mm vs 4·0±0·5mm;P=0·014)and following recompensation (3·4±0·5mmvs 3·8±0·2mm;P=0·032). The brachialartery diameter during recompensation expressed as a percentageof the baseline value was similar at both intervals (decompensationvs recompensation: 117±14% vs 116±10%;P=ns). Atthe time of decompensation, the correlation between TNF- andthe percentage change in brachial artery diameter followingreactive hyperaemia was absent (r=0·098;P=0·719).The same correlation became significant at the time of recompensation(r=0·750;P=0·001). Conclusions In patients with congestive heart failure, plasma levels ofpro-inflammatory cytokines correlate with endothelium-dependentvasodilation of the brachial artery following recompensation,but not during an acute episode of heart failure.