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Circulating levels of tumor necrosis factor alpha, brain natriuretic peptide and cardiac Troponin I upon admission and 31-day mortality in patients with acute decompensated chronic heart failure


Elevated circulating levels of TNFα, brain natriuretic peptide (BNP) and cardiac Troponin I (cTnI) have been connected with adverse prognosis in patients with chronic heart failure (CHF). However, there are scant data about the predictive value of these biomarkers in combination.


A total of 577 consecutive patients (mean age: 73 ± 9 years), who were hospitalized for acute decompensation of NYHA class III/IV (65.3% of ischemic etiology) low-output (mean LVEF: 22 ± 5) CHF, were studied. Biochemical markers were measured upon admission. The incidence of 31-day death was the prespecified primary endpoint.


The incidence of the primary endpoint was 17.7%. By multivariate Cox analysis, including baseline characteristics and the study biomarkers, elevated circulating levels of TNFα (RR = 2.1; P < 0.001), BNP (RR = 3.5; P < 0.001) and cTnI (RR = 3.8; P < 0.001) were independently associated with the primary endpoint. When the patients were divided according to the number of positive biomarkers (estimated by ROC analysis) there was a significant gradual increase in the rate of the primary endpoint with increasing of the number of the positive biomarkers (4.1%, 10%, 21.5% and 53.5% 31-day mortality rate for patients with zero, one, two and three positive biomarkers, respectively; P < 0.001) (Figure 1).

Figure 1



The present results suggest that in patients hospitalized due to acutely decompensated severe low-output CHF, serum levels of TNFα, BNP and cTnI can be used in combination for enhanced early risk stratification.

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  • Primary Endpoint
  • Chronic Heart Failure
  • Brain Natriuretic Peptide
  • Cardiac Troponin
  • NYHA Class