Kim Tae-Hun, Kim Hyungseop, Kim In-Cheol
a Division of Cardiology, Department of Internal Medicine , Keimyung University Dongsan Medical Center , Daegu , Republic of Korea.
Acute Card Care. 2015 Dec;17(4):72-76. doi: 10.1080/17482941.2016.1203440. Epub 2016 Aug 5.
The prognosis of acute heart failure (HF) can be determined by cardio-renal function which is assessed by cystatin-C (Cys-C). We evaluated whether Cys-C could be a more useful prognostic indicator in acute HF, compared with uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Two hundred thirty-two HF patients in the emergency room were studied using measurements of Cys-C, UA, and NT-proBNP. During the follow-up, cardiac events, defined as the composites of recurrent HF or cardiac death, were determined.
Seventy-seven cardiac events (28 cardiac deaths, 49 recurrent HFs) occurred over two years. The events group revealed higher levels of Cys-C, UA, and NT-proBNP. They showed increased blood urea nitrogen and creatinine, reduced septal tissue Doppler velocity (TVI-Sm), and low frequencies of beta-blockers (BB), diuretics and angiotensin-converting enzyme inhibitors/-receptor blockers. Cys-C (the best cutoff: 1.7 mg/l) had a steady, persistent hazard ratio (HR) over two years. On multivariate analysis, Cys-C, TVI-Sm, and BB were significant predictors for adverse events. Cys-C provided an incremental value for prognosis more than NT-proBNP and UA did over the follow-up period.
Compared with UA and NT-proBNP, Cys-C could be better prognostic biomarker for cardiac events two years after acute HF.
急性心力衰竭（HF）的预后可通过胱抑素C（Cys-C）评估的心脏和肾功能来确定。我们评估了与尿酸（UA）和N端前脑钠肽（NT-proBNP）相比，Cys-C是否可能是急性HF中更有用的预后指标。
对急诊室的232例HF患者进行了Cys-C、UA和NT-proBNP的检测。在随访期间，确定心脏事件，定义为复发性HF或心源性死亡的综合情况。
两年内发生了77例心脏事件（28例心源性死亡，49例复发性HF）。事件组的Cys-C、UA和NT-proBNP水平较高。他们的血尿素氮和肌酐升高，室间隔组织多普勒速度（TVI-Sm）降低，β受体阻滞剂（BB）、利尿剂和血管紧张素转换酶抑制剂/受体阻滞剂的使用频率较低。Cys-C（最佳截断值：1.7mg/l）在两年内具有稳定、持续的风险比（HR）。多变量分析显示，Cys-C、TVI-Sm和BB是不良事件的重要预测因素。在随访期间，Cys-C对预后的预测价值超过NT-proBNP和UA。
与UA和NT-proBNP相比，Cys-C可能是急性HF后两年心脏事件更好的预后生物标志物。
