Document Detail


Cystatin C identifies patients with stable chronic heart failure at increased risk for adverse cardiovascular events.
MedLine Citation:
PMID:  22899766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Renal function is a strong predictor of adverse events in heart failure. Current renal function measures are imperfect, and cystatin C (CysC) is promoted as a better marker of glomerular filtration rate. This study compares the prognostic use of CysC and derived glomerular filtration rate estimates with other measures of renal function in patients with chronic heart failure.
METHODS AND RESULTS: We measured serum CysC levels in 823 patients with heart failure undergoing coronary angiography with follow-up of major adverse cardiovascular events (death, myocardial infarction, stroke). CysC levels strongly correlated with creatinine (r=0.73), blood urea nitrogen (r=0.70), and estimated glomerular filtration rate by the 4-variable modification of diet in renal disease equation (r=-0.62) (all P<0.001). However, the correlation was lower in estimated glomerular filtration rate ≥60 mL/min per 1.73 m(2). CysC-based measures significantly improved areas under the receiver operating characteristic curve for the prediction of major adverse cardiovascular events, especially in estimated glomerular filtration rate ≥60 mL/min per 1.73 m(2) (P<0.01). Net reclassification improvement was 22.2% (P<0.001) in this group. CysC remained an independent predictor of major adverse cardiovascular events (P<0.001) after adjustment for traditional risk factors and brain natriuretic peptide.
CONCLUSIONS: CysC is an independent predictor of adverse events in chronic heart failure. It adds prognostic value to creatinine, particularly in patients with preserved renal function.
Authors:
Matthias Dupont; Yuping Wu; Stanley L Hazen; W H Wilson Tang
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-08-16
Journal Detail:
Title:  Circulation. Heart failure     Volume:  5     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-19     Completed Date:  2012-12-03     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  602-9     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00590200
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Biological Markers / blood
Cardiovascular Diseases / blood,  diagnosis*,  mortality,  physiopathology
Chi-Square Distribution
Chronic Disease
Coronary Angiography
Cystatin C / blood*
Female
Glomerular Filtration Rate
Heart Failure / blood,  diagnosis*,  mortality,  physiopathology
Humans
Kaplan-Meier Estimate
Kidney / metabolism,  physiopathology*
Male
Middle Aged
Models, Biological
Multivariate Analysis
Myocardial Infarction / blood,  diagnosis,  mortality,  physiopathology
Natriuretic Peptide, Brain / blood
Ohio
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Risk Assessment
Risk Factors
Stroke / blood,  diagnosis,  mortality,  physiopathology
Grant Support
ID/Acronym/Agency:
1P20HL113452-01/HL/NHLBI NIH HHS; 1R01HL103931-02/HL/NHLBI NIH HHS; 5P01HL103453/HL/NHLBI NIH HHS; P01 HL076491/HL/NHLBI NIH HHS; P01 HL098055/HL/NHLBI NIH HHS; P01 HL103453/HL/NHLBI NIH HHS; P01HL076491-055328/HL/NHLBI NIH HHS; P01HL098055-01/HL/NHLBI NIH HHS; P20 HL113452/HL/NHLBI NIH HHS; R01 HL103866/HL/NHLBI NIH HHS; R01 HL103931/HL/NHLBI NIH HHS; R01HL103866/HL/NHLBI NIH HHS; UL1 TR000439/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/CST3 protein, human; 0/Cystatin C; 114471-18-0/Natriuretic Peptide, Brain
Comments/Corrections

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