Type D personality is associated with increased levels of tumour necrosis factor (TNF)-α and TNF-α receptors in chronic heart failure

Background Pro-inflammatory cytokines and their circulating receptors are powerful predictors of poor outcome in patients with chronic heart failure (CHF). We hypothesized that Type D personality, known to independently predict long-term mortality in patients with coronary heart disease, would relate to immune activation in CHF. Methods 91 stable CHF patients (79% males, mean age 57 ± 13 yrs, 58% ischemic heart disease) with left ventricular ejection fraction ≤ 35% completed a psychological questionnaire to assess Type D personality (i.e., the tendency to experience negative emotions and to inhibit their expression). Plasma levels of tumour necrosis factor (TNF)-α, soluble TNF-α receptor 1 and 2 (sTNFR1 and sTNFR2) and interleukin-6 (IL-6) were measured by ELISA. Results Type D patients (n = 30) had higher levels of TNF-α (5.1 ± 2.9 versus 3.9 ± 2.6 pg/ml, p = 0.066), sTNFR1 (1656 ± 1057 versus 1098 ± 424 pg/ml, p = 0.009) and sTNFR2 (2869 ± 1510 versus 2011 ± 794 pg/ml, p = 0.006) as compared to non-Type D patients (n = 61), whereas IL-6 was not different. After controlling for sex, age, ischemic etiology and disease severity, multivariate analysis yielded Type D as the strongest predictor of increased TNF-α (OR = 2.9, p = 0.048) and sTNFR2 levels (OR = 3.9, p = 0.018). For sTNFR1, the effect of Type D was no longer significant in this analysis (OR = 2.7, p = 0.112). Conclusions Type D personality was independently associated with increased circulating levels of TNF-α and sTNFR2 in patients with CHF. This study provides the strongest evidence to date that chronic emotional distress may be associated with immune activation in heart failure.