Prognostic value and echocardiographic determinants of plasma myeloperoxidase levels in chronic heart failure
Prognostic value and echocardiographic determinants of plasma myeloperoxidase levels in chronic heart failure
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DOI：
10.1016/j.jacc.2007.02.053
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发表时间：
2007-06-19
影响因子：
24
通讯作者：
Klein, Allan L.
中科院分区：
文献类型：
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作者：
Wilson Tang, W. H.;Tong, Wilson;Klein, Allan L.
目的本研究的目的是探讨髓过氧化物酶（MPO）与心脏结构、性能和预后的关系。背景髓过氧化物酶是一种炎症标志物，在心力衰竭（HF）和心功能不全患者中升高，与斑块易损性和左心室（LV）重塑有机械联系。Cleveland，俄亥俄州），140例慢性收缩期HF患者（左室射血分数< 35%），并检查血浆MPO水平与超声心动图收缩和舒张性能指标以及长期临床结局的关系（死亡、心脏移植或HF住院）。血浆MPO水平升高与更晚期HF的可能性增加相关（限制性舒张期，右室收缩功能不全≥ 3+，三尖瓣反流面积≥ 1.8 cm（2））。血浆MPO水平可预测长期临床结局（风险比[95%可信区间] = 3.35 [1.52 - 8.86]），即使在校正年龄、左室射血分数、血浆B型利钠肽（BNP）、肌酐清除率或舒张期后也是如此。在受试者-操作者特征曲线分析中，在BNP检测中加入MPO增加了对未来不良临床事件的预测准确性（仅BNP的曲线下面积为0.66 [卡方检验= 12.9，p = 0.0003]，BNP加MPO的曲线下面积为0.70 [卡方检验15.87，p = 0.0004]）。结论在慢性收缩期HF中，升高的血浆MPO水平与更晚期HF的可能性增加有关。此外，HF受试者血浆MPO水平升高似乎预示不良临床结局增加。
ObjectivesThe purpose of this study was to explore the relationship between myeloperoxidase (MPO) and cardiac structure, performance, and prognosis.BackgroundMyeloperoxidase is an inflammatory marker that is elevated in patients with heart failure (HF) and cardiac dysfunction, with mechanistic links to plaque vulnerability and left ventricular (LV) remodeling.MethodsWe evaluated plasma MPO levels (CardioMPO, PrognostiX, Inc., Cleveland, Ohio) in 140 patients with chronic systolic HF (LV ejection fraction < 35%) and examined the plasma MPO levels' relationships with echocardiographic indexes of systolic and diastolic performance, as well as long-term clinical outcomes (death, cardiac transplantation, or HF hospitalization).ResultsWithin the overall cohort, increasing plasma MPO levels were associated with increasing likelihood of more advanced HF (restrictive diastolic stage, right ventricular systolic dysfunction >= 3+, and tricuspid regurgitation area >= 1.8 cm(2)). Plasma MPO levels were predictive of long-term clinical outcomes (risk ratio [95% confidence interval] = 3.35 [1.52 to 8.86]), even after adjustment for age, LV ejection fraction, plasma B-type natriuretic peptide (BNP), creatinine clearance, or diastolic stage. In receiver-operator characteristic curve analyses, addition of MPO to BNP testing augmented the predictive accuracy of future adverse clinical events (area under the curve 0.66 for BNP only [chi-square test = 12.9, p = 0.0003], and 0.70 for BNP plus MPO [chi-square test 15.87, p = 0.0004]).ConclusionsIn chronic systolic HF, elevated plasma MPO levels are associated with an increased likelihood of more advanced HF. Moreover, elevated plasma MPO levels within a HF subject seem to be predictive of increased adverse clinical outcomes.