A.M. Vasylenko, S.O. Sheiko Relation between the levels of tumor necrosis factor alpha and erythropoietin in blood of elderly patients with chronic heart failure and manifestations of anemia syndrome

The aim of the work was to define the link between the level of erythropoietin (ERP) and pro-inflammatory cytokine – tumor necrosis factor alpha (TNF-α) in elderly patients with chronic heart failure (CHF) and
manifestations of anemia syndrome (AS) depending on functional class (FC) of CHF and left ventricular (LV) ejection fraction. 179 patients of elderly age with CHF and manifestations of AS were examined. It was elucidated that in 13.1 % of elderly patients with CHF of III–IV functional class (FC) with preserved ejection fraction (EF) of the left ventricle (LV) and in 41,7 % of elderly patients with CHF with decreased EF of LV and manifestations of AS the growth of the level of TNF-α occurs in parallel with decrease of hemoglobin (Hb) and increase of ERP in blood serum. This may testify to development of erythropoietin resistance caused by the increased activity of cytokine system. Increase of the level of circulating erythropoietin on the background of increased concentration of TNF-α in elderly patients with CHF and manifestation of AS occurs proportionally to the increase of FC of CHF. This testifies to a negative role of activity of a given pro-inflammatory cytokine in development of CHF in elderly age patients. In 50 % of elderly patients with CHF of III–IV FC with preserved EF of LV and manifestations of AS and in 49.5 % of elderly patients with decreased EF of LV growth of the level of TNF-α is accompanied with decrease of erythropoietin level. This is probably related to the inhibiting impact of pro-inflammatory cytokine of TNF-α on synthesis of the latter. Presence of correlative reliable links between erythropoietin concentration and TNF-α and between the level of ERP and FC of CHF explains to a great extent mechanisms of formation of cardio-renal AS in elderly patients with CHF.

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