Prognostic value of plasma neutrophil gelatinase-associated lipocalin for cardiovascular events in patients with chronic heart failure and atrial fibrillation

Abstract

Funding Acknowledgements Type of funding sources: None. We aimed to assess the prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL), a marker of renal tubular damage, in patients with heart failure with or without atrial fibrillation (AF). Methods The study involved 113 (83.2% men) patients with mean age 60.0 [54.0-67.0] years with II-IV functional class (recommendations of the New York Heart Association) is due to ischemic heart disease. Serum levels of NGAL were quantified by ELISA. Echocardiography was performed according to the American Society of Echocardiography/European Association of Echocardiography recommendations. Receiver operating characteristic (ROC) curve analysis was used to determine the best NGAL cut-off to predict events. Cox proportional hazards models were used to investigate the prospective association between NGAL and events during follow-up. Outcome was cumulative incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke, HF hospitalization) at 36 months. Results Median plasma NGAL in patients with and without AF was 34 (25-46) ng/ml and 26 (18-44) ng/ml, p<0.01, respectively. The ROC curve showed an optimal admission NGAL level cut-off >25.5 ng/mL, with 70% sensitivity and 89% specificity. The area under the ROC curve (AUC) was (0.814; p<0.01). In patients with CHF and atrial fibrillation multivariable analysis shows, that NGAL independently associated with outcomes (HR 2.35, 95% CI 1.2-4.61; p<0.01). Conclusions Admission plasma NGAL >25.5 ng/ml appears a sensible tool for in-hospital AF prediction as well as an marker for adverse cardiovascular outcome during long-term follow-up period.