Hyperhomocysteinemia in patients with symptomatic chronic heart failure: Prevalence and prognostic importance—pilot study

Naruszewicz, Marek; Jankowska, Ewa A.; Zymliński, Robert; Bukowska, H.; Millo, Barbara; Banasiak, Waldemar; Ponikowski, Piotr

doi:10.1016/j.atherosclerosis.2006.08.014

Cited by 31 publications

(33 citation statements)

References 35 publications

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“…When the first model, which included LVEF, was considered, the independent determinants of total homocysteine in the whole population were serum creatinine, LVEF, CRP and vitamin B 12 ( Table 2, first model). NT-pro-BNP, creatinine, urea, CRP and vitamin B 12 were the independent determinants of total homocysteine in the second model (Table 2, second model). Multiple regression of the first model confirmed the significant association of total homocysteine with LVEF and serum creatinine when the analysis was restricted either to CAD patients (b-coefficient = -0.191, P = 0.0009, and b-coefficient = 0.300, P < 0.0001, respectively) or to non-CAD patients (b-coefficient = -0.234, P = 0.0064, and b-coefficient = 0.348, P < 0.0001, respectively).…”

Section: Resultsmentioning

confidence: 99%

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Left ventricular systolic dysfunction is an independent predictor of homocysteine in angiographically documented patients with or without coronary artery lesions

Guéant-Rodríguez

Juillière

Nippert

et al. 2007

Journal of Thrombosis and Haemostasis

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Summary. Background: Elevated plasma homocysteine is a risk factor for coronary artery disease (CAD) and thromboembolic disorders that seems also to be associated with chronic heart failure. Objective: To evaluate the association between homocysteine and left ventricular dysfunction and to assess whether it is independent of CAD. Patients and methods: A prospective study evaluated this relationship in 709 patients referred for diagnostic coronary angiography, including 515 CAD and 194 patients without evidence of coronary artery lesions. Results: The homocysteine level was significantly higher in the 187 patients with a left ventricular ejection fraction (LVEF) dysfunction < 40% (P < 0.0001) than in those without ventricular dysfunction. LVEF, NYHA functional class II or III and CAD, stable angina and hypertension were clinical characteristics that influenced total homocysteine level in univariate analysis. Homocysteine was significantly associated with LVEF and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in univariate regression (r = -0.267, 95% CI -0.33 to -0.19, P < 0.0001, and r = 0.381, 95% CI 0.28-0.47, P < 0.0001, respectively) and in multiple regression (P = 0.0022 and P = 0.0001, respectively). Other determinants were creatinine and vitamin B 12 , but not folate. LVEF was a predictor of homocysteine > 15 lmol L )1 in the whole population (P for trend £ 0.0001) and in patients without documented CAD (P for trend = 0.0058). Conclusion: Our results showed an association of homocysteine with left ventricular systolic dysfunction and NT-pro-BNP that existed independently of documented CAD. Whether this association reflects a causative factor or a consequence of CHF and influences the prognosis of the disease remains an open question.

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Section: Resultsmentioning

confidence: 99%

“…LVEF < 40% was used as the threshold for defining a left ventricular systolic dysfunction (LVSD) [18]. Venous blood from fasting subjects was immediately centrifuged and stored at -20°C until analysis of vitamin B 12 and folate. Other parameters were immediately assayed.…”

Section: Methodsmentioning

confidence: 99%

Left ventricular systolic dysfunction is an independent predictor of homocysteine in angiographically documented patients with or without coronary artery lesions

Guéant-Rodríguez

Juillière

Nippert

et al. 2007

Journal of Thrombosis and Haemostasis

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“…Hyperhomocysteinemia is regarded as an important index reflecting clinical aspects of CHF severity and generalized metabolic imbalance [26]. It is not clear whether hyperhomocysteinemia is a mechanistically involved risk factor for CHF or only a risk indicator without any direct effects on the myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…Severe symptoms of exercise intolerance in patients with hyperhomocysteinemia may be a result of elevated homocysteine levels adversely affecting vasodilatory endothelial function [14,15]. It is well known that intact vasodilation in exercising skeletal muscle is an important determinant of exercise capacity [26]. The impact of measures for lowering HCY levels on functional capacity in CHF with preserved LVEF requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Homocysteine Levels in Patients with Heart Failure with Preserved Ejection Fraction

et al. 2010

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Objectives: Increased homocysteine (HCY) levels are associated with an increased risk of cardiovascular disease. Plasma HCY is increased in chronic heart failure (CHF) patients, and previous studies suggest that hyperhomocysteinemia causes adverse cardiac remodeling and affects pump function. We aimed to evaluate the HCY levels in patients with diastolic heart failure with preserved left ventricular ejection fraction (LVEF). Methods: We prospectively studied 68 patients (39 females and 29 males) who were hospitalized for symptomatic heart failure, as well as 40 age- and sex-matched healthy subjects who comprised the control group. CHF was diagnosed in all cases based on Framingham diagnostic criteria. CHF with preserved LVEF was defined as cases with CHF with an LVEF of 50% or more. Patients with regional left ventricular wall motion abnormalities, atrial fibrillation, and renal failure were excluded. Results: The mean age was 65.5 ± 9.6 years in the heart failure group and 65.2 ± 9.7 years in the control group. The mean LVEF was 59.8 ± 5.3 in the heart failure group and 61.4 ± 5.2 in the control group. The mean total fasting HCY concentrations were significantly higher in patients with heart failure (16.9 ± 5.27 µmol/l vs. 10.15 ± 3.49 µmol/l, respectively; p < 0.001). Multiple regression analysis indicated that NT-proBNP, hs-CRP, E/A ratio, and HbA1C were independently associated with hyperhomocysteinemia. Conclusions: Our results suggest that hyperhomocysteinemia is prevalent in heart failure with preserved ejection fraction. Larger scale studies are needed to clarify its pathogenic mechanisms and effects on the natural history of heart failure.

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“…Recent data indicate that high-dose B vitamin supplementation significantly reduces progression of early-stage subclinical atherosclerosis (carotid IMT) in healthy individuals at low risk for cardiovascular disease [19,20] . It has also been shown that in patients with moderate-severe chronic HF mildly elevated levels of plasma homocysteine are related to poor survival independently of other established prognostic factors [21] .…”

Section: Discussionmentioning

confidence: 99%

Reduced Kidney Function Estimated by Cystatin C and Clinical Outcomes in Hypertensive Patients with Coronary Artery Disease: Association with Homocysteine and Other Cardiovascular Risk Factors

Dzielińska

Januszewicz

Wiȩcek

et al. 2010

Kidney Blood Press Res

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Aims: To evaluate the association between serum cystatin C and homocysteine concentrations, cardiovascular risk factors and cardiovascular events in hypertensive patients with coronary artery disease (CAD). Methods: 260 patients with hypertension and CAD (mean age 56.9 ± 9.3) were included. During a mean 40-month follow-up the combined end-point of death from all causes, non-fatal myocardial infarction and stroke or coronary revascularization was assessed. Results: Subjects in the highest serum cystatin C quartile (>103.4 nmol/l) as compared with the lowest were older, were characterized by a higher frequency of multivessel CAD, higher levels of homocysteine (13.2 ± 5.2 vs. 11.4 ± 4.2 µmol/l; p < 0.01), fibrinogen and high-sensitivity C-reactive protein and by an increased intima-media thickness. Combined end-point occurred twice as frequently in the 4th quartile of serum cystatin C as compared with the 1st quartile (10.8 vs. 20.3%; p = 0.11). In an univariate analysis, but not in a multivariate model, cystatin C concentration predicted the combined end-point (Exp(B) = 1.096; p < 0.05). Conclusion: In hypertensive patients with CAD, serum cystatin C level was independently associated with the extent of CAD, homocysteine plasma level and traditional vascular risk factors. However, serum cystatin C concentration did not independently predict the combined end-point.

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Hyperhomocysteinemia in patients with symptomatic chronic heart failure: Prevalence and prognostic importance—pilot study

Cited by 31 publications

References 35 publications

Left ventricular systolic dysfunction is an independent predictor of homocysteine in angiographically documented patients with or without coronary artery lesions

Left ventricular systolic dysfunction is an independent predictor of homocysteine in angiographically documented patients with or without coronary artery lesions

Homocysteine Levels in Patients with Heart Failure with Preserved Ejection Fraction

Reduced Kidney Function Estimated by Cystatin C and Clinical Outcomes in Hypertensive Patients with Coronary Artery Disease: Association with Homocysteine and Other Cardiovascular Risk Factors

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