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Alzaabi MA, Abdelsalam A, Alhammadi M, Bani Hani H, Almheiri A, Al Matrooshi N, Al Zaman K. Evaluating Biomarkers as Tools for Early Detection and Prognosis of Heart Failure: A Comprehensive Review. Card Fail Rev 2024; 10:e06. [PMID: 38915376 PMCID: PMC11194781 DOI: 10.15420/cfr.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/19/2024] [Indexed: 06/26/2024] Open
Abstract
There is a high prevalence of heart failure (HF) worldwide, which has significant consequences for healthcare costs, patient death and quality of life. Therefore, there has been much focus on finding and using biomarkers for early diagnosis, prognostication and therapy of HF. This overview of the research presents a thorough examination of the current state of HF biomarkers and their many uses. Their function in diagnosing HF, gauging its severity and monitoring its response to therapy are all discussed. Particularly promising in HF diagnosis and risk stratification are the cardiac-specific biomarkers, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Markers of oxidative stress, extracellular matrix, renal function, inflammation and cardiac peptides have shown promise in evaluating HF severity and prognosis. MicroRNAs and insulin-like growth factor are two emerging biomarkers that have shown potential in helping with HF diagnosis and prognosis.
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Affiliation(s)
- Moza A Alzaabi
- Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu DhabiAbu Dhabi, United Arab Emirates
| | - Amin Abdelsalam
- Department of Cardiology, Al Qassemi HospitalSharjah, United Arab Emirates
| | - Majid Alhammadi
- College of Medicine, University of SharjahSharjah, United Arab Emirates
| | - Hasan Bani Hani
- College of Medicine, University of SharjahSharjah, United Arab Emirates
| | - Ali Almheiri
- College of Medicine, University of SharjahSharjah, United Arab Emirates
| | - Nadya Al Matrooshi
- Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu DhabiAbu Dhabi, United Arab Emirates
| | - Khaled Al Zaman
- Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu DhabiAbu Dhabi, United Arab Emirates
- College of Medicine, University of SharjahSharjah, United Arab Emirates
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Serum Cystatin C: A Potential Biomarker in Pulmonary Hypertension in Children. Indian J Pediatr 2023; 90:417. [PMID: 36729369 DOI: 10.1007/s12098-023-04487-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023]
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Manguba AS, Vela Parada X, Coca SG, Lala A. Synthesizing Markers of Kidney Injury in Acute Decompensated Heart Failure: Should We Even Keep Looking? Curr Heart Fail Rep 2019; 16:257-273. [DOI: 10.1007/s11897-019-00448-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Cystatin C for predicting all-cause mortality and rehospitalization in patients with heart failure: a meta-analysis. Biosci Rep 2019; 39:BSR20181761. [PMID: 30643006 PMCID: PMC6361773 DOI: 10.1042/bsr20181761] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/09/2018] [Accepted: 11/27/2018] [Indexed: 12/23/2022] Open
Abstract
Circulating cystatin C (cys-C/CYC) has been identified as an independent predictor of all-cause mortality in patients with coronary artery disease and the general population. This meta-analysis aimed to systematically evaluate the association between elevated cys-C level and all-cause mortality and rehospitalization risk amongst patients with heart failure (HF). PubMed and Embase databases were searched until December 2017. All prospective observational studies that reported a multivariate-adjusted risk estimate of all-cause mortality and/or rehospitalization for the highest compared with lowest cys-C level in HF patients were included. Ten prospective studies involving 3155 HF patients were included. Meta-analysis indicated that the highest compared with lowest cys-C level was associated with an increased risk of all-cause mortality (hazard ratio (HR): 2.33; 95% confidence intervals (CI): 1.67-3.27; I2 = 75.0%, P<0.001) and combination of mortality/rehospitalization (HR: 2.06; 95%CI: 1.58-2.69; I2 = 41.6%, P=0.181). Results of stratified analysis indicated that the all-cause mortality risk was consistently found in the follow-up duration, cys-C cut-off value or type of HF subgroup. Elevated cys-C level is possibly associated with an increased risk of all-cause mortality and rehospitalization in HF patients. This increased risk is probably independent of creatinine or estimated glomerular filtration rate (eGFR).
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Josa-Laorden C, Sola A, Giménez-López I, Rubio-Gracia J, Garcés-Horna V, Pérez-Calvo J. Valor pronóstico de la ratio urea / creatinina en la insuficiencia cardiaca descompensada y su relación con el daño renal agudo. Rev Clin Esp 2018; 218:232-240. [DOI: 10.1016/j.rce.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/01/2018] [Accepted: 03/14/2018] [Indexed: 12/28/2022]
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Josa-Laorden C, Sola A, Giménez-López I, Rubio-Gracia J, Garcés-Horna V, Pérez-Calvo J. Prognostic value of the urea:creatinine ratio in decompensated heart failure and its relationship with acute kidney damage. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rceng.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chen W, Tian T, Wang S, Xue Y, Sun Z, Wang S. Characteristics of carotid atherosclerosis in elderly patients with type 2 diabetes at different disease course, and the intervention by statins in very elderly patients. J Diabetes Investig 2018; 9:389-395. [PMID: 28685957 PMCID: PMC5835477 DOI: 10.1111/jdi.12710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/10/2017] [Accepted: 07/03/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Chronic complications of diabetes have become the leading cause of death in elderly patients with diabetes. Carotid atherosclerosis, one of the major complications, was evaluated and the effects of atorvastatin on carotid atherosclerosis in very elderly patients with type 2 diabetes were observed. MATERIALS AND METHODS Patients were divided into three groups: (i) disease course <5 years; (ii) disease course 5-10 years; (iii) disease course >10 years, and carotid atherosclerosis was evaluated. The very elderly patients were treated with statins, and the effect was observed. RESULTS Carotid intima-media thickness values, plaque instability and levels of homocysteine, cystatin, and C-reactive protein in diabetes patients were significantly higher than those in the healthy control group, whereas levels of C-peptide and estimated glomerular filtration rate in the patients were significantly lower. In patients with type 2 diabetes for >10 years, intima-media thickness values and plaque instability were obviously higher than those in patients with type 2 diabetes for <5 years, while levels of fasting C-peptide and estimated glomerular filtration rate were lower than those in patients with type 2 diabetes for <5 years. In the very elderly patients, after statins treatment, intima-media thickness values, levels of homocysteine and C-reactive protein were significantly reduced, as well as the number of unstable plaques. CONCLUSIONS In the elderly patients with type 2 diabetes, carotid atherosclerosis-related factors increased obviously, and renal function declined obviously, which were closely related to the disease course. Atorvastatin significantly reduced homocysteine and C-reactive protein, and delayed and reversed the progress of carotid atherosclerosis in very elderly patients with type 2 diabetes.
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Affiliation(s)
- Wenjun Chen
- Department of OncologyLinyi People's HospitalLinyiChina
| | - Tao Tian
- Department of GeriatricsLinyi People's HospitalLinyiChina
| | - Shiming Wang
- Department of GeriatricsLinyi People's HospitalLinyiChina
| | - Yan Xue
- Ultrasound RoomLinyi People's HospitalLinyiChina
| | - Zongqin Sun
- Department of Clinical LaboratoryLinyi People's HospitalLinyiChina
| | - Shuli Wang
- Department of GeriatricsLinyi People's HospitalLinyiChina
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Pérez-Calvo J, Rubio-Gracia J, Josa-Laorden C. Letter to the Editor regarding the article 'Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3' by Zivlas et al. (2017). Ther Adv Cardiovasc Dis 2018; 12:175-176. [PMID: 29421960 DOI: 10.1177/1753944718756545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Juan Pérez-Calvo
- Instituto de Investigación Sanitaria de Aragón - Servicio de Medicina Interna, Hospital Clínico Universitario "Lozano Blesa", Avda San Juan Bosco, 15, Zaragoza 50009, Spain
| | - Jorge Rubio-Gracia
- Instituto de Investigación Sanitaria de Aragón - Servicio de Medicina Interna, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Claudia Josa-Laorden
- Instituto de Investigación Sanitaria de Aragón - Servicio de Medicina Interna, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
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Breidthardt T, Sabti Z, Ziller R, Rassouli F, Twerenbold R, Kozhuharov N, Gayat E, Shrestha S, Barata S, Badertscher P, Boeddinghaus J, Nestelberger T, Mueller C. Diagnostic and prognostic value of cystatin C in acute heart failure. Clin Biochem 2017; 50:1007-1013. [PMID: 28756070 DOI: 10.1016/j.clinbiochem.2017.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The accurate early diagnosis of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Cystatin C might improve the early detection of AKI. METHODS 207 patients presenting to the emergency department with AHF were enrolled. Cystatin C was measured in plasma in a blinded fashion at presentation and serially thereafter. The potential of Cystatin C levels to predict AKI was assessed as the primary endpoint. Long-term mortality was assessed as a secondary endpoint. RESULTS At presentation, creatinine (140μmol/L [91-203] vs. 97μmol/L [76-132], p<0.01) and Cystatin C (2.00mg/L [1.30-3.08] vs. 1.45mg/L [1.00-1.90], p<0.01) levels were significantly higher in AKI compared to Non-AKI patients. The diagnostic accuracy for AKI quantified by the area under the receiver operating characteristic curve was mediocre and comparable for both markers (creatinine 0.68; 95%CI 0.58-78 vs. Cystatin C 0.67; 95%CI 0.58-0.76). Serial measurements of Cystatin C did not further increase the prognostic accuracy for AKI. Cystatin C levels were significantly higher in decedents than in survivors (1.90mg/L [1.30-2.70] vs. 1.30mg/L [1.0-1.6], p<0.001). The combination of Cystatin C and BNP levels significantly improved the prediction of mortality provided by either parameter alone. In multivariable regression analysis Cystatin C remained independently associated with mortality (HR 1.41; 95%CI 1.02-1.95). CONCLUSION Plasma Cystatin C levels do not adequately predict AKI in patients with AHF. However, in multivariable regression analysis Cystatin C predicted mortality after the adjustment for baseline renal function, AKI, BNP levels and heart failure risk factors.
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Affiliation(s)
- Tobias Breidthardt
- Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland.
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Ronny Ziller
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Geriatric Medicine, Spital Interlaken, Switzerland
| | - Frank Rassouli
- Medical University Clinic, Kantonsspital, Aarau, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Etienne Gayat
- Hôpital Lariboisière APHP, University of Paris, France
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Sara Barata
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Thomas Nestelberger
- Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
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Cleland JG, Teerlink JR, Davison BA, Shoaib A, Metra M, Senger S, Milo O, Cotter G, Bourge RC, Parker JD, Jondeau G, Krum H, O'Connor CM, Torre-Amione G, van Veldhuisen DJ, McMurray JJ. Measurement of troponin and natriuretic peptides shortly after admission in patients with heart failure-does it add useful prognostic information? An analysis of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Studies (V. Eur J Heart Fail 2017; 19:739-747. [DOI: 10.1002/ejhf.786] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- John G.F. Cleland
- University of Hull, Kingston upon Hull; UK
- National Heart and Lung Institute; Royal Brompton and Harefield Hospitals NHS Trust, Imperial College; London UK
| | - John R. Teerlink
- University of California, San Francisco and the San Francisco Veterans Affairs Medical Center; San Francisco CA USA
| | | | | | - Marco Metra
- University of Brescia, Piazza Spedali Civili; Brescia Italy
| | | | - Olga Milo
- Momentum Research, Inc.; Durham NC USA
| | | | | | - John D. Parker
- Division of Cardiology; Mount Sinai Hospital; Toronto Ontario Canada
| | | | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine; Alfred Hospital, Monash University; Melbourne Australia (deceased 28 November 2015)
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Renal function assessment in heart failure. Rev Clin Esp 2017; 217:267-288. [PMID: 28258719 DOI: 10.1016/j.rce.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/17/2016] [Accepted: 01/14/2017] [Indexed: 11/23/2022]
Abstract
Renal function is one of the most consistent prognostic determinants in heart failure. The prognostic information it provides is independent of the ejection fraction and functional status. This article reviews the various renal function assessment measures, with special emphasis on the fact that the patient's clinical situation and response to the heart failure treatment should be considered for the correct interpretation of the results. Finally, we review the literature on the performance of tubular damage biomarkers.
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Renal biomarkers and outcomes in outpatients with heart failure: The Atlanta cardiomyopathy consortium. Int J Cardiol 2016; 218:136-143. [DOI: 10.1016/j.ijcard.2016.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 01/09/2023]
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Kim TH, Kim H, Kim IC. The potential of cystatin-C to evaluate the prognosis of acute heart failure: A comparative study. ACTA ACUST UNITED AC 2016; 17:72-76. [PMID: 27494366 DOI: 10.1080/17482941.2016.1203440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prognosis of acute heart failure (HF) can be determined by cardio-renal function which is assessed by cystatin-C (Cys-C). We evaluated whether Cys-C could be a more useful prognostic indicator in acute HF, compared with uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS Two hundred thirty-two HF patients in the emergency room were studied using measurements of Cys-C, UA, and NT-proBNP. During the follow-up, cardiac events, defined as the composites of recurrent HF or cardiac death, were determined. RESULTS Seventy-seven cardiac events (28 cardiac deaths, 49 recurrent HFs) occurred over two years. The events group revealed higher levels of Cys-C, UA, and NT-proBNP. They showed increased blood urea nitrogen and creatinine, reduced septal tissue Doppler velocity (TVI-Sm), and low frequencies of beta-blockers (BB), diuretics and angiotensin-converting enzyme inhibitors/-receptor blockers. Cys-C (the best cutoff: 1.7 mg/l) had a steady, persistent hazard ratio (HR) over two years. On multivariate analysis, Cys-C, TVI-Sm, and BB were significant predictors for adverse events. Cys-C provided an incremental value for prognosis more than NT-proBNP and UA did over the follow-up period. CONCLUSIONS Compared with UA and NT-proBNP, Cys-C could be better prognostic biomarker for cardiac events two years after acute HF.
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Affiliation(s)
- Tae-Hun Kim
- a Division of Cardiology, Department of Internal Medicine , Keimyung University Dongsan Medical Center , Daegu , Republic of Korea
| | - Hyungseop Kim
- a Division of Cardiology, Department of Internal Medicine , Keimyung University Dongsan Medical Center , Daegu , Republic of Korea
| | - In-Cheol Kim
- a Division of Cardiology, Department of Internal Medicine , Keimyung University Dongsan Medical Center , Daegu , Republic of Korea
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Absence of cystatin C involvement in ventricular remodelling and heart failure. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Inazumi H, Koyama S, Tanada Y, Fujiwara H, Takatsu Y, Sato Y. Prognostic significance of changes in cystatin C during treatment of acute cardiac decompensation. J Cardiol 2016; 67:98-103. [DOI: 10.1016/j.jjcc.2015.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/20/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
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Pérez-Calvo JI, Castiella Muruzábal T, Búcar Barjud M, Josa Laorden C, Sánchez Marteles M, Lacambra Blasco I, Asensio López MC, Pascual Figal DA. Absence of cystatin C involvement in ventricular remodelling and heart failure. Rev Clin Esp 2015; 216:55-61. [PMID: 26670860 DOI: 10.1016/j.rce.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/08/2015] [Accepted: 11/01/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF. PATIENTS AND METHODS We analysed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease. RESULTS For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases. CONCLUSIONS Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF.
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Affiliation(s)
- J I Pérez-Calvo
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa Facultad de Medicina, Instituto de investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España.
| | - T Castiella Muruzábal
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Lozano Blesa Facultad de Medicina, Zaragoza, España
| | - M Búcar Barjud
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Instituto de investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - C Josa Laorden
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Instituto de investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - M Sánchez Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Instituto de investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - I Lacambra Blasco
- Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M C Asensio López
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca Facultad de Medicina, Murcia, España
| | - D A Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca Facultad de Medicina, Murcia, España
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Pérez Calvo JI, Puente Lanzarote JJ. Cistatina C, muchas respuestas y algunas cuestiones pendientes. Med Clin (Barc) 2015; 145:201-2. [DOI: 10.1016/j.medcli.2015.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022]
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Villanueva MP, Mollar A, Palau P, Carratalá A, Núñez E, Santas E, Bodí V, Chorro FJ, Miñana G, Blasco ML, Sanchis J, Núñez J. Procalcitonin and long-term prognosis after an admission for acute heart failure. Eur J Intern Med 2015; 26:42-8. [PMID: 25592074 DOI: 10.1016/j.ejim.2014.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/09/2014] [Accepted: 12/25/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Traditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes. METHODS AND RESULTS We measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regression methods were used to evaluate the association between PCT and the risk of death and recurrent rehospitalizations, respectively. At a median follow-up of 2years (IQR: 1.0-2.8), 108 deaths, 170 all-cause rehospitalizations and 96 AHF-rehospitalizations were registered. In an adjusted analysis, including well-established risk factors such as natriuretic peptides and indices of renal function, the logarithm of PCT was associated with a higher risk of death (HR=1.43, CI 95%: 1.12-1.82; p=0.004), all-cause rehospitalizations (IRR=1.22, CI 95% 1.02-1.44; p=0.025) and AHF-rehospitalizations (IRR=1.28, CI 95%: 1.02-1.61; p=0.032). The association with these endpoints persisted after adjustment for other inflammatory biomarkers such as white blood cells, C-reactive protein and interleukins. CONCLUSION In patients with AHF and no evidence of infection, PCT was independently and positively associated with the risk of long-term death and recurrent rehospitalizations.
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Affiliation(s)
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital de la Plana, Villarreal, Spain
| | - Arturo Carratalá
- Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital de Manises, Valencia, Spain
| | - Maria L Blasco
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
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Carrasco-Sánchez FJ, Pérez-Calvo JI, Morales-Rull JL, Galisteo-Almeda L, Páez-Rubio I, Barón-Franco B, Aguayo-Canela M, Pujol-De la llave E. Heart failure mortality according to acute variations in N-terminal pro B-type natriuretic peptide and cystatin C levels. J Cardiovasc Med (Hagerstown) 2014; 15:115-21. [PMID: 24522084 DOI: 10.2459/jcm.0b013e3283654bab] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM Changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cystatin C (CysC) are predictors of adverse outcomes in acute heart failure. This study assess whether NT-proBNP variations might provide independent information in addition to that obtained from CysC levels. METHODS NT-proBNP levels were assessed in patients admitted due to acute heart failure using an observational study. Patients were classified as follows: group 1, those with a decrease in NT-proBNP levels of at least 30% from admission to 4 weeks after discharge; group 2, those with no significant changes in levels; and group 3, those who showed an increase in NT-proBNP of 30%. A multivariable Cox regression model and c-statistics were used. The primary end-point was all-cause mortality at 1-year follow-up. RESULTS A total of 195 patients completed the follow-up. The mortality rate reached 20.5% (40 patients); 14 out of the 32 in group 3. The cumulative incidence of death, according to the change in NT-proBNP and Kaplan-Meier analysis, showed a significant increase in group 3 (log-rank P = 0.004). In the multivariable analysis, NT-proBNP variation for group 3 (hazard ratio 4.27; P <0.001) and for group 2 (hazard ratio 2.19; P = 0.043) in comparison with group 1 were independently associated with all-cause mortality, as well as anemia, hyponatremia, and admission CysC levels. Patients in group 3, and those with levels of serum CysC above the median, were also associated with slight increase in mortality. CONCLUSION An increase of at least 30% in NT-proBNP levels after hospitalization is related to all-cause mortality in patients with acute heart failure and provides supplementary prognostic information in patients with high levels of CysC. A decrease in NT-proBNP of at least 30% is a desirable target to achieve.
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Affiliation(s)
- Francisco J Carrasco-Sánchez
- aDepartment of Internal Medicine, Hospital Juan Ramón Jiménez, Huelva bDepartment of Internal Medicine, Hospital Clinic University 'Lozano Blesa', Zaragoza cDepartment of Clinical Chemistry and Laboratory Medicine, Hospital Juan Ramón Jiménez, Huelva, Spain
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Fenster BE, Lasalvia L, Schroeder JD, Smyser J, Silveira LJ, Buckner JK, Brown KK. Cystatin C: a potential biomarker for pulmonary arterial hypertension. Respirology 2014; 19:583-9. [PMID: 24628703 DOI: 10.1111/resp.12259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/30/2013] [Accepted: 01/14/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Cystatin C (CysC), a novel marker of renal function, predicts left heart failure and cardiovascular mortality. The hypothesis that serum CysC levels correlate with right ventricular (RV) morphology, function and pressure in pulmonary arterial hypertension (PAH) was tested. METHODS As part of a prospective study, 14 PAH subjects and 10 matched controls underwent same-day echocardiography, cardiac magnetic resonance imaging (CMR), and phlebotomy for CysC, brain natriuretic peptide (BNP), and N-terminal BNP (NT-ProBNP). RV ejection fraction (RVEF), end-diastolic volume, end-systolic volume and mass were calculated using CMR. RV systolic pressure (RVSP), strain and diastolic function (including tricuspid valve (TV) E velocity, A velocity, e' velocity, E/A ratio and E/e' ratio) were assessed using echocardiography. RESULTS RVSP was significantly elevated in PAH subjects versus controls (57 ± 17 vs. 28 ± 8 mm Hg, P < 0.0001). CysC was abnormally elevated in the PAH cohort when compared with controls (1.00 ± 0.23 vs 0.78 ± 0.05 mg/L, P = 0.001). CysC positively correlated with RVSP (rho 0.61, P = 0.002), RV end-diastolic volume (rho 0.50, P = 0.01), RV end-systolic volume (rho 0.58, P = 0.003), mass index (rho 0.66, P = 0.0004), strain (rho 0.51, P = 0.01) and strain rate (rho 0.51, P = 0.01) and negatively correlated with RVEF (rho -0.58, P = 0.003) and TV e' (rho -0.75, P < 0.0001). The same correlations with BNP and NT-ProBNP were comparable with CysC. CONCLUSIONS In a small cohort, CysC accurately correlates with RV pressure, function and morphology. CysC may represent a novel PAH biomarker.
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Affiliation(s)
- Brett E Fenster
- Division of Cardiology, National Jewish Health, Denver, Colorado, USA
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Li X, Zhu H, Li P, Xin Q, Liu J, Zhang W, Xing YH, Xue H. Serum cystatin C concentration as an independent marker for hypertensive left ventricular hypertrophy. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:286-90. [PMID: 24133518 PMCID: PMC3796704 DOI: 10.3969/j.issn.1671-5411.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/13/2013] [Accepted: 06/27/2013] [Indexed: 01/15/2023]
Abstract
Background Serum cystatin C levels can be used to predict morbidity and mortality in patients with cardiovascular disease. However, the clinical relevance of serum cystatin C levels in patients with hypertensive left ventricular hypertrophy (LVH) has rarely been investigated. We designed the present study to investigate whether serum cystatin C levels are associated with cardiac structural and functional alterations in hypertensive patients. Methods We enrolled 823 hypertensive patients and classified them into two groups: those with LVH (n = 287) and those without LVH (n = 536). All patients underwent echocardiography and serum cystatin C testing. We analyzed the relationship between serum cystatin C levels and LVH. Results Serum cystatin C levels were higher in hypertensive patients with LVH than in those without LVH (P < 0.05). Using linear correlation analysis, we found a positive correlation between serum cystatin C levels and interventricular septal thickness (r = 0.247, P < 0.01), posterior wall thickness (r = 0.216, P < 0.01), and left ventricular weight index (r = 0.347, P < 0.01). When analyzed by multiple linear regression, the positive correlations remained between serum cystatin C and interventricular septal thickness (β = 0.167, P < 0.05), posterior wall thickness (β = 0.187, P < 0.05), and left ventricular weight index (β = 0.245, P < 0.01). Conclusion Serum cystatin C concentration is an independent marker for hypertensive LVH.
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Affiliation(s)
- Xin Li
- Clinical Department of Medicine, Chinese PLA General Hospital, Beijing 100853, China
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Renal function measurements and mortality in patients with acute heart failure. Int J Cardiol 2013; 168:4990-1. [DOI: 10.1016/j.ijcard.2013.07.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 07/13/2013] [Indexed: 11/24/2022]
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Kapoor SS. Cystatin C and its emerging role in oncology: clinical benefit beyond its prognostic role in heart failure. Eur J Intern Med 2013; 24:e76. [PMID: 23791477 DOI: 10.1016/j.ejim.2013.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 12/09/2022]
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