# Association of TNF-R1 with Exercise Capacity in Asymptomatic Hypertensive Heart Disease—Mediating Role of Left Ventricular Diastolic Function Deterioration

## TL;DR

Higher levels of TNF-R1 are linked to worse exercise capacity in people with early heart disease, possibly due to heart function changes.

## Contribution

Identifies TNF-R1 as an independent predictor of exercise capacity in asymptomatic hypertensive heart disease, mediated by diastolic dysfunction.

## Key findings

- Higher TNF-R1 levels correlate with lower peak VO2 in asymptomatic hypertensive heart disease patients.
- LV diastolic function mediates the relationship between TNF-R1 and exercise capacity.
- TNF-R1 remains a significant determinant of peak VO2 after adjusting for covariates.

## Abstract

Background: TNF receptor 1 (TNF-R1) mediates the proinflammatory and proapoptotic effects of TNF-alpha, with its soluble form predicting incident heart failure (HF). While there is evidence linking TNF pathway activation to cardiac dysfunction, the mechanisms involved remain unclear. This study aimed to investigate the association between TNF-R1, exercise capacity, and cardiac function in asymptomatic patients with hypertensive heart disease (HHD). Methods: We enrolled 80 patients (mean age 55 ± 12 years) with HHD and no clinical symptoms of HF (stages A and B). Echocardiography, including tissue Doppler and left atrial and left ventricular (LV) strain assessment, was performed at rest. Peripheral venous blood samples were collected to measure serum TNF-R1 concentration. Results: The study population was divided into two subsets based on the median exercise capacity (peak VO2) value. Patients with higher VO2 had lower serum TNF-R1 concentration and higher early peak mitral annular velocity (e’) and peak atrial longitudinal strain (PALS). After adjusting for other covariates, multivariable regression analysis identified TNF-R1 as an independent determinant of peak VO2. Mediation analysis revealed that the relationship between TNF-R1 and peak VO2 was mediated by LV diastolic function (PALS or e’), with a decrease in the beta coefficient after including mediator variables from 0.37 (p < 0.001) to 0.30 (p < 0.006) and 0.31 (p = 0.004), respectively. Conclusions: In patients with HHD, higher TNF-R1 levels are associated with lower exercise capacity, which may be mediated by impaired LV diastolic function. These findings might suggest a role of TNF signalling in early HF development, justifying further studies to evaluate TNF-R1 as a biomarker for risk of HF progression.