Alexanian Ioannis, Parissis John, Farmakis Dimitrios, Athanaselis Sotirios, Pappas Loukas, Gavrielatos Gerasimos, Mihas Constantinos, Paraskevaidis Ioannis, Sideris Antonios, Kremastinos Dimitrios, Spiliopoulou Chaido, Anastasiou-Nana Maria, Lekakis John, Filippatos Gerasimos
Department of Cardiology, Athens University Hospital Attikon, Athens, Greece.
Clin Res Cardiol. 2014 Nov;103(11):938-49. doi: 10.1007/s00392-014-0735-x. Epub 2014 Jun 8.
Emerging evidence suggests a pathophysiological role of micronutrient dyshomeostasis in heart failure, including promotion of adverse remodeling and clinical deterioration. We sought to evaluate serum copper (Cu) and zinc (Zn) levels in acute (AHF) and chronic (CHF) heart failure.
We studied 125 patients, 71 % male, aged 69 ± 11 years, 37 % with preserved left ventricular ejection fraction (LVEF ≥40 %) (HFPEF), including 81 with AHF and 44 with CHF; 21 healthy volunteers served as controls. Serum Cu and Zn levels were determined using air-acetylene flame atomic absorption spectrophotometry.
Serum Cu levels were significantly higher in AHF (p = 0.006) and CHF (p = 0.002) patients compared to controls after adjusting for age, gender and comorbidities, whereas they did not differ between AHF and CHF (p = 0.840). Additionally, serum Cu in patients with LVEF <40 % was significantly higher compared to both controls (p < 0.001) and HFPEF patients (p = 0.003). Serum Zn was significantly lower in AHF (p < 0.001) and CHF (p = 0.039) compared to control after adjusting for the above-mentioned variables. Moreover, serum Zn was significantly lower in AHF than in CHF (p = 0.015). In multiple linear regression, LVEF (p = 0.033) and E/e ratio (p = 0.006) were independent predictors of serum Cu in total heart failure population, while NYHA class (p < 0.001) and E/e ratio (p = 0.007) were independent predictors of serum Zn.
Serum Cu was increased both in AHF and CHF and correlated with LV systolic and diastolic function. Serum Zn, in contrast, was decreased both in AHF and CHF and independently predicted by clinical status and LV diastolic function.
新出现的证据表明，微量营养素动态平衡失调在心力衰竭中具有病理生理作用，包括促进不良重塑和临床病情恶化。我们试图评估急性心力衰竭（AHF）和慢性心力衰竭（CHF）患者的血清铜（Cu）和锌（Zn）水平。
我们研究了125例患者，男性占71%，年龄69±11岁，37%的患者左心室射血分数保留（LVEF≥40%）（HFpEF），其中81例为AHF患者，44例为CHF患者；21名健康志愿者作为对照。采用空气-乙炔火焰原子吸收分光光度法测定血清铜和锌水平。
在对年龄、性别和合并症进行校正后，AHF患者（p = 0.006）和CHF患者（p = 0.002）的血清铜水平显著高于对照组，而AHF和CHF患者之间无差异（p = 0.840）。此外，LVEF<40%的患者血清铜水平显著高于对照组（p < 0.001）和HFpEF患者（p = 0.003）。在对上述变量进行校正后，AHF患者（p < 0.001）和CHF患者（p = 0.039）的血清锌水平显著低于对照组。此外，AHF患者的血清锌水平显著低于CHF患者（p = 0.015）。在多元线性回归中，LVEF（p = 0.033）和E/e比值（p = 0.006）是总心力衰竭人群血清铜的独立预测因素，而纽约心脏协会（NYHA）分级（p < 0.001）和E/e比值（p = 0.007）是血清锌的独立预测因素。
AHF和CHF患者的血清铜均升高，且与左心室收缩和舒张功能相关。相比之下，AHF和CHF患者的血清锌均降低，并由临床状态和左心室舒张功能独立预测。
