Document Detail

Relation of circulating cardiac myosin light chain 1 isoform in stable severe congestive heart failure to survival and treatment with flosequinan.
MedLine Citation:
PMID:  12398964     Owner:  NLM     Status:  MEDLINE    
The myocardial contractile protein myosin light chain 1 isoform (MLC-1) is released into the circulation during myocyte necrosis and could thus be a marker of low-grade myocardial damage and of poor prognosis in patients with heart failure. Two hundred eighteen patients with stable heart failure (ejection fraction [EF] <35%) and in New York Heart Association (NYHA) class III to IV had MLC-1 measured at baseline and 1 month after being randomized to the direct vasodilator flosequinan or placebo. Patients were followed a mean of 302 +/- 142 days. The prognostic value of an increase in MLC-1 above the 98th percentile of normal controls was compared with that of conventional prognostic variables in heart failure. MLC-1 was increased in over half of patients at baseline and 1 month, and this was associated with increased age, NYHA class IV, and renal insufficiency. By Kaplan-Meier survival analysis, patients with a baseline increase in MLC-1 had a greater mortality (26%) than those without an increase (15%) (p = 0.043). A significant interaction among MLC-1, survival, and treatment was found (p = 0.043). In the placebo group, MLC-1 was associated with increased mortality (29% vs 12%, p = 0.025), whereas there was no significant difference among patients receiving flosequinan. In a multivariate logistic regression model including age, treatment, and left ventricular (LV) ejection fraction, the MLC-1 chain was most predictive of mortality (p = 0.049). Thus, circulating MLC-1 is elevated in over half of patients with stable severe heart failure, and this increase is associated with a poor prognosis. Flosequinan treatment eliminates this association, highlighting the complexity of the relation between cardiac myocyte damage, drug treatment, and mortality.
Mark S Hansen; Eric B Stanton; Yehia Gawad; Milton Packer; Bertram Pitt; Karl Swedberg; Jean L Rouleau;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  90     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-10-25     Completed Date:  2002-12-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  969-73     Citation Subset:  AIM; IM    
Division of Cardiology of the University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
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MeSH Terms
Aged, 80 and over
Biological Markers / blood
Double-Blind Method
Follow-Up Studies
Heart Failure / blood*,  drug therapy*,  mortality
Middle Aged
Multivariate Analysis
Myosin Light Chains / blood*,  drug effects*
North America
Predictive Value of Tests
Prospective Studies
Quinolines / therapeutic use*
Severity of Illness Index
Stroke Volume / drug effects,  physiology
Survival Analysis
Treatment Outcome
Vasodilator Agents / therapeutic use*
Reg. No./Substance:
0/Biological Markers; 0/Myosin Light Chains; 0/Quinolines; 0/Vasodilator Agents; 76568-02-0/flosequinan

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