Cystatin C concentration as a predictor of systolic and diastolic heart failure

JOURNAL OF CARDIAC FAILURE

卷:14

Article

Moran, Andrew^1,2  Smith, Nicolas L.³  Fried, Linda F.⁴  Sarnak, Mark J.⁵  Seliger, Stephen L.⁶  Psaty, Bruce³  Siscovick, David S.³  Gottdiener, John S.⁷  Shlipak, Michael G.^1,2 

[1] Vet Adm Med Ctr, Gen Internal Med Sect, San Francisco, CA 94121 USA

[2] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA

[3] Univ Washington, Cardiovasc Hlth Res Unit, Seattle, WA 98195 USA

[4] Vet Affairs Pittsburgh Healthcare Syst, Renal Sect, Med Serv, Pittsburgh, PA USA

[5] Tufts Univ New England Med Ctr, Boston, MA USA

[6] Univ Maryland, Baltimore, MD 21201 USA

[7] Univ Maryland, Sch Med, Div Cardiol, Baltimore, MD 21201 USA

关键词: cystatin C;    diastolic heart failure;    ejection fraction;    elderly;    estimated glomerular filtration rate;    heart failure;    systolic heart failure;   

DOI  :  10.1016/j.cardfail.2007.09.002

来源: Elsevier

【 摘 要 】

Background: Risk factors for heart failure (HF) may differ according to ejection fraction (EF). Higher cystatin C, a marker of kidney dysfunction, is associated with incident HF, but previous studies did not determine EF at diagnosis. We hypothesized that kidney dysfunction would predict diastolic HF (DHF) better than systolic HF (SHF) in the Cardiovascular Health Study. Methods and Results: Cystatin C was measured in 4453 participants without HF at baseline. Incident HF was categorized as DHF (EF >= 50%) or SHF (EF < 50%). We compared the association of cystatin C with the risk for DHF and SHE after adjustment for age, sex, race, medications, and HF risk factors. During 8 years of follow-up, 167 participants developed DHF and 206 participants developed SHE After adjustment, sequentially higher quartiles of cystatin C were associated with risk for SHF (competing risks hazard ratios 1.0 [reference], 1.99 [95% confidence interval 1.14-3.48], 2.32 [1.32-4.07], 3.17 [1.82-5.50], P for trend < .001). The risk for DHF was apparent only at the highest cystatin C quartile (hazard ratios 1.0 [reference], 1.09 [0.62-1.89], 1.08 [0.61-1.93], and 1.83 [1.07-3.11]). Conclusions: Cystatin C levels are linearly associated with the incidence of systolic HF, whereas only the highest concentrations of cystatin C predict diastolic HF.

【 授权许可】

Free