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TLR-4 expression predicts mortality in patients with acute heart failure

Session ACVC Essentials 4 You - ePublications

Speaker Konstantin A Krychtiuk

Event : ACVC Essentials 4 You 2020

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Biomarkers
  • Session type : ePublication

Authors : M Lenz (Vienna,AT), KA Krychtiuk (Vienna,AT), K Huber (Vienna,AT), C Hengstenberg (Vienna,AT), J Wojta (Vienna,AT), G Heinz (Vienna,AT), WS Speidl (Vienna,AT)

M Lenz1 , KA Krychtiuk1 , K Huber2 , C Hengstenberg1 , J Wojta1 , G Heinz1 , WS Speidl1 , 1Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology - Vienna - Austria , 2Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine - Vienna - Austria ,



Inflammation is regarded as an important trigger for disease progression in heart failure (HF) and was implicated in the pathophysiology of acute heart failure (AHF).

Toll-like receptors (TLRs) play an important role in acute inflammatory processes in critically ill patients by binding to pathogen associated molecular patterns (PAMPs) and danger associated molecular patterns (DAMPs). However, it is not known whether the expression patterns of TLRs on neutrophils and monocytes are associated with outcome in patients with severe AHF requiring intensive care unit (ICU) admission.


The aim of this prospective, observational study was to analyze whether TLR-expression on monocytes or neutrophils is associated with 30-day survival in patients with severe AHF.


We included 90 patients with severe AHF admitted to our cardiac ICU. Blood was taken on admission and mean fluorescence intensity (MFI) of TLR-2, TLR-4 and TLR-9 on monocytes and neutrophils was analyzed by flow cytometry.


Median age was 65 (IQR 49-74) years and 76.8% of patients were male. Median NT-proBNP was 4941 (IQR 1298-12273) pg/mL and 30-day mortality was 36%.

TLR-4 expression on monocytes in survivors (740 IQR 694-854) was significantly lower than in non-survivors (871 IQR 723-979; p<0.05). TLR-2 and TLR-9 expression on monocytes and TLR expression on neutrophils was not associated with survival. TLR-4 expression on monocytes was significantly associated with survival independent of age, sex, creatinine and NT-proBNP levels.

Of interest, monocyte subset distribution 72 hours after admission towards an increase in the intermediate subset with a consecutive decrease in classical monocytes was associated with 30-day mortality.


Monocyte TLR-4 expression predicts mortality in patients admitted to a cardiac ICU for severe AHF. This suggests that activation of the innate immune system by TLR-binding of DAMPs may play a significant role in critically ill AHF patients.

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