BACKGROUND: Patients with chronic heart failure (CHF) may be particularly susceptible to unfavorable effects of hyperhomocysteinemia (HHcy). The aim of this study was to assess the prevalence of HHcy (plasma homocysteine [Hcy]>or=14 micromol/L) in an unselected cohort of CHF patients, its clinical determinants, and prognostic implications. METHODS AND RESULTS: In 108 consecutive CHF patients (81 men, age: 66+/-11 years) with mean plasma Hcy level 12.5+/-5.5 micromol/L (range 2.3-28.3 micromol/L), 38 (35%) patients demonstrated HHcy. Among clinical and metabolic parameters, in multivariable regression models, advanced NYHA class (P<0.0001), plasma NT-proBNP (P<0.001), peak oxygen consumption (P<0.05), reduced glomerular filtration rate (P<0.0001) and elevated serum uric acid (P<0.05) predicted high plasma Hcy level. HHcy was related to increased mortality (HR=3.26, 95% CI: 1.78-5.98, P=0.0001), also when adjusted for conventional prognosticators in multivariable models (all P<0.01). In patients with HHcy, a 3-year survival was 37% (95% CI: 22-52%) as compared to 73% (95% CI: 63-83%) in those with normal Hcy levels (P<0.0001). CONCLUSIONS: HHcy is common in CHF, is related to the disease severity, depicts generalized metabolic imbalance (evidenced by hyperuricaemia), and independently predicts poor long-term prognosis.
BACKGROUND:Patients with chronic heart failure (CHF) may be particularly susceptible to unfavorable effects of hyperhomocysteinemia (HHcy). The aim of this study was to assess the prevalence of HHcy (plasma homocysteine [Hcy]>or=14 micromol/L) in an unselected cohort of CHFpatients, its clinical determinants, and prognostic implications. METHODS AND RESULTS: In 108 consecutive CHFpatients (81 men, age: 66+/-11 years) with mean plasma Hcy level 12.5+/-5.5 micromol/L (range 2.3-28.3 micromol/L), 38 (35%) patients demonstrated HHcy. Among clinical and metabolic parameters, in multivariable regression models, advanced NYHA class (P<0.0001), plasma NT-proBNP (P<0.001), peak oxygen consumption (P<0.05), reduced glomerular filtration rate (P<0.0001) and elevated serum uric acid (P<0.05) predicted high plasma Hcy level. HHcy was related to increased mortality (HR=3.26, 95% CI: 1.78-5.98, P=0.0001), also when adjusted for conventional prognosticators in multivariable models (all P<0.01). In patients with HHcy, a 3-year survival was 37% (95% CI: 22-52%) as compared to 73% (95% CI: 63-83%) in those with normal Hcy levels (P<0.0001). CONCLUSIONS: HHcy is common in CHF, is related to the disease severity, depicts generalized metabolic imbalance (evidenced by hyperuricaemia), and independently predicts poor long-term prognosis.
Authors: Lina Miao; Ming Guo; Deng Pan; Pengfei Chen; Zhuhong Chen; Jie Gao; Yanqiao Yu; Dazhuo Shi; Jianpeng Du Journal: Front Med (Lausanne) Date: 2021-12-14