Herrmann Markus, Taban-Shomal Omid, Hübner Ulrich, Böhm Michael, Herrmann Wolfgang
Institut für Klinische Chemie und Laboratoriumsmedizin/Zentrallabor, Universitätsklinikum des Saarlandes, D-66421 Homburg/Saar, Germany.
Eur J Heart Fail. 2006 Oct;8(6):571-6. doi: 10.1016/j.ejheart.2005.11.016. Epub 2006 Feb 28.
Chronic heart failure (CHF) is a major public health problem causing considerable morbidity and mortality. Recently, plasma homocysteine (HCY) has been suggested to be increased in CHF patients potentially representing a newly recognized risk marker. This manuscript reviews the existing literature regarding hyperhomocysteinemia (HHCY) and CHF. Clinical data indicate that HHCY is associated with an increased incidence of CHF as well as with the severity of the disease. Mechanistic studies of HHCY and CHF are rare. However, preliminary results suggest that HHCY causes adverse cardiac remodelling characterized by interstitial and perivascular fibrosis resulting in increased myocardial stiffness. In addition, HHCY seems to affect the pump function of the myocardium. The mechanisms leading from an elevated HCY level to reduced pump function and adverse cardiac remodelling are a matter of speculation. Existing data indicate that direct effects of HCY on the myocardium as well as NO independent vascular effects are involved. In conclusion, HHCY might be a potential aetiological factor in CHF. Future studies need to clarify the mechanistic role of HHCY in CHF as a useful paradigm with most interesting therapeutic implications, because HCY lowering therapy could favourably influence the prognosis in CHF patients.
慢性心力衰竭（CHF）是一个重大的公共卫生问题，会导致相当高的发病率和死亡率。最近，有研究表明慢性心力衰竭患者血浆同型半胱氨酸（HCY）水平升高，这可能是一种新发现的风险标志物。本文综述了关于高同型半胱氨酸血症（HHCY）与慢性心力衰竭的现有文献。临床数据表明，高同型半胱氨酸血症与慢性心力衰竭的发病率增加以及疾病的严重程度相关。关于高同型半胱氨酸血症与慢性心力衰竭的机制研究很少。然而，初步结果表明，高同型半胱氨酸血症会导致不良的心脏重塑，其特征是间质和血管周围纤维化，导致心肌僵硬度增加。此外，高同型半胱氨酸血症似乎会影响心肌的泵功能。从同型半胱氨酸水平升高到泵功能降低和不良心脏重塑的机制尚不清楚。现有数据表明，同型半胱氨酸对心肌的直接作用以及不依赖一氧化氮的血管作用都参与其中。总之，高同型半胱氨酸血症可能是慢性心力衰竭的一个潜在病因。未来的研究需要阐明高同型半胱氨酸血症在慢性心力衰竭中的机制作用，这是一个具有最有趣治疗意义的有用范例，因为降低同型半胱氨酸水平的治疗可能会对慢性心力衰竭患者的预后产生有利影响。
