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[Pathophysiological role of cytokines in heart failure].

Plasma and myocardial levels of proinflammatory cytokines such as tumor necrosis factor(TNF)-alpha, interleukin 1beta, and interleukin 6 are elevated in patients with heart failure. Not only viral infection but also cardiac overload, ischemia, and neuro-humoral factors stimulate systemic and myocardial production of these cytokines. Administration of proinflammatory cytokines directly depresses myocardial contractility in vitro and in vivo. In addition, TNF and interleukin induce myocardial apoptosis and promote cardiac hypertrophy and fibrosis, suggesting that these cytokines are involved in the progression of cardiac remodeling. Vasoactive peptides such as endothelin and adrenomedullin also have cytokine-like functions in the heart, acting as autocrine and paracrine factors. Thus, proinflammatory cytokines and these peptides play important roles in the pathogenesis and pathophysiology of heart failure.