Background: The influence of myocardial function on plasma levels of cystatin C (CysC), a sensitive marker of renal function, in chronic systolic heart failure (HF) has not been well established. Methods: We prospectively identified 139 subjects with stable, chronic HF (left ventricular ejection fraction ≤ 35%) and measured plasma levels of CysC. We prospectively tracked patients' long-term adverse clinical outcomes (death, cardiac transplantation, and HF hospitalizations). Results: Plasma levels of CysC were elevated in 41% of patients with preserved renal function and directly correlated with N-terminal prohormone brain natriuretic peptide (r = 0.57, P < .0001). There was a significant association between CysC and mitral E/septal E' ratio (r = 0.34, P < .001), right ventricular systolic dysfunction severity (r = 0.30, P < .001), and mitral regurgitation severity (r = 0.31, P < .001), but not left ventricular ejection fraction. At the cutoff of 1.23 mg/dL, CysC remains a significant independent risk factor for adverse clinical outcomes (hazard ratio 1.88, 95% confidence interval 1.15-3.09, P = .012) after adjusting for estimated glomerular filtration rate, left ventricular ejection fraction, and E/septal E'. Conclusion: CysC is associated with more advanced left ventricular diastolic dysfunction and right ventricular systolic dysfunction and remains an independent predictor of long-term prognosis in chronic systolic HF after adjusting for myocardial factors.
Bibliographical noteFunding Information:
The main study (Assessment of Doppler Echocardiography in Prognosis and Therapy study) was partially supported by research grants from the American Society of Echocardiography, GlaxoSmithKline Pharmaceuticals, and Roche Diagnostics Inc.
Copyright 2008 Elsevier B.V., All rights reserved.
- Cystatin C
- diastolic function
- heart failure
- natriuretic peptide