Prognostic value of interleukin-8 as a predictor of heart failure in patients with myocardial infarction and percutaneous intervention

BACKGROUND: Recent studies have shown that pro-inflammatory cytokines play a significant contributory role in the pathogenesis of the acute heart failure. The purpose of this study was to determine whether the serum IL-8 concentration in patients with acute myocardial infarction (AMI), who were undergoing percutaneous coronary intervention (PCI) was related to the subsequent presence or absence of heart failure. METHODS: The study included 50 patients who underwent successful PCI. During their subsequent stay in the coronary care unit, their maximum degree of heart failure was recorded. Patients were then divided into two groups: group A (Killip I) and group B (Killip class > I). The serum IL-8 concentration was measured during the 24 h following admission to the coronary care unit. RESULTS: Serum levels of IL-8 in the group B were significantly higher than those of group A (P < 0.001). By multivariante analysis a higher level of IL-8 was a significant predictor of heart failure after PCI. CONCLUSIONS: Serum levels of IL-8 after PCI appear to be a predictor for the development of heart failure in patients with AMI.     

血清尿酸与慢性心力衰竭患者预后的相关性及其预测价值

目的 分析血清尿酸(UA)与慢性心力衰竭（CHF）患者预后的相关性及其预测价值。 方法 入选CHF患者60例，随访1年，按随访期内是否发生心血管事件分为事件组（n = 21）和非事件组(39)，做UA与CHF患者预后的相关性分析，并用ROC曲线初步评价UA对CHF预后的预测价值。 结果 事件组和非事件组UA水平分别为(486 ± 70）μmol/L和(338±86）μmol/L（P<0.01）；与非事件组比较，事件组患者左室舒张末期内径（LVEDD）,左房内径（LAD）,房颤发生率显著增加，左室射血分数（LVEF）显著下降(P<0.01)。多因素分析显示:UA是CHF患者预后的独立相关因素，Pearson相关性分析结果显示，UA与年龄、尿素氮、肌酐、氨基末端脑钠肽前体及心血管不良事件发生率呈正相关(分别为r = 0.12、r = 0.26、r = 0.21和r = 0.24，r = 0.31.均P<0.01)；与LVEF值呈负相关(r = ?0.56，P<0.01)。以UA数值445 μmol/L为截断点，UA数值预测心血管不良事件发生率的灵敏度为85%，特异度为98%，准确度为93%。 结论 UA是CHF患者预后的独立相关因素，UA对CHF心血管不良事件发生的预测是有价值的。     

尿酸对老年冠心病心力衰竭患者预后的影响

目的：分析老年冠心病心力衰竭患者的尿酸水平对预后的影响.方法：选择2005年1月～2007年12月入住心内科的老年冠心病合并慢性心衰患者783例.按尿酸水平的四分位间距分为低水平组（195例）、较低水平组（195例）、较高水平组（195例）和高水平组（198例）,比较各组的病死率.按随访期是否死亡分为死亡组（199例）和生存组（584例）,采用多因素Cox回归分析尿酸对冠心病合并心衰患者预后的影响.结果：尿酸各组的病死率有显著差异（P＜0.01）,高水平组最高,达43.4％,显著高于其他三组（P均＜0.05）.与生存组比较,死亡组患者年龄较大[（70.03±9.67）岁比（73.31±8.69）岁],尿酸[（353.28±122.58） μmol/L比（423.71±189.84） μmol/L]水平显著升高,合并贫血（17.6％比24.1％）、房颤（17.5％比31.2％）、肾衰竭（22.1％比34.7％）的比例显著增加,左室射血分数[（56.49±11.14）％比（49.43±12.19）％]显著下降（P＜0.05或＜0.01）.Cox回归分析显示,高水平的尿酸（≥437 μmol/L）、年龄、NYHAⅢ～Ⅳ级及房颤是老年冠心病心衰预后不良的独立危险因素（HR 0.596～1.547,P均＜0.05）.结论：血尿酸作为老年冠心病心衰患者心源性死亡的预后指标,其作用独立于影响心衰患者生存的其他因素,具有一定的临床预后判断价值.     

血清肝细胞生长因子与高血压患者合并急性冠脉综合征的相关性

目的 探讨肝细胞生长因子（HGF）在原发性高血压及急性冠脉综合征（ACS）患者血清中的表达水平及其临床意义.方法 采用双抗体夹心酶联免疫荧光吸附法（ELISE）测定25例单纯高血压患者、20例高血压合并不稳定型心绞痛（UA）患者、25例高血压合并急性心肌梗死（AMI）患者、25名健康者的HGF血清浓度.结果 单纯高血压组、高血压合并UA组和高血压合并AMI组血清HGF浓度较正常对照组明显高,差异有统计学意义（P＜0.01）;高血压合并UA组、高血压合并AMI组血清HGF浓度较单纯高血压组明显高,差异有统计学意义（P＜0.05）;高血压合并AMI组血清HGF浓度较高血压合并UA组明显高,差异有统计学意义（P＜0.05）.结论 高浓度的HGF与血管内皮损伤和修复以及不稳定的粥样斑块破裂有关.测定HGF浓度将成为早期诊断高血压及其分级的重要指标和早期筛查不稳定冠状动脉粥样硬化斑块的新手段.     

血尿酸水平与慢性心力衰竭患者心功能状态的相关性分析

摘要　目的 研究血尿酸水平与慢性心衰患者心功能状态的相关性。方法：回顾收集2012年10月至2014年10月航空总医院心内科因慢性心力衰竭住院的患者200例,同期收集非心衰入院患者180例为对照组,收集患者基本资料及检验结果,采用logistic回归,分析高尿酸血症与慢性心力衰竭发生的相关性。并依据尿酸水平,将200例心衰患者分为尿酸正常组、轻度高尿酸血症组、显著高尿酸血症组,统计分析心衰患者中血尿酸水平与患者心功能状态的关系。结果：慢性心力衰竭组血尿酸水平明显高于非心衰组患者。高尿酸血症与慢性心力衰竭发生的OR 值为2. 244 ( P <0. 05)。慢性心力衰竭患者中,高尿酸血症者较尿酸正常者,心功能状态更差,且随着尿酸水平的升高,心功能指标进一步恶化。结论: 慢性心力衰竭患者高尿酸血症发生率更高,高尿酸血症可能是慢性心衰的危险因素。血尿酸水平越高,患者心功能状态越差。     

Serum uric acid levels correlate with the severity and the mortality of primary pulmonary hypertension.

Serum uric acid (UA), the final product of purine degradation, has been proposed to be a marker for impaired oxidative metabolism and a possible predictor of mortality in patients with chronic heart failure. To elucidate whether serum UA correlates with the severity and the mortality of primary pulmonary hypertension (PPH), serum UA was assessed in 90 patients with PPH together with other clinical variables. Right heart catheterization was performed in all patients. Serum UA was significantly elevated in patients with PPH compared with age-matched control subjects (7.5 +/- 2.5 versus 4.9 +/- 1.2 mg/ml, p < 0.001). Serum UA negatively correlated with cardiac output (r = -0.52, p < 0.001) and positively correlated with total pulmonary resistance (r = 0.57, p < 0.001). Serum UA significantly decreased from 7.1 +/- 1.9 to 5.9 +/- 1.6 mg/dl with vasodilator therapy, associated with a reduction in total pulmonary resistance from 22 +/- 6 to 17 +/- 7 Wood units. During a mean follow-up period of 31 mo, 53 patients died of cardiopulmonary causes. Among noninvasive variables, serum UA was independently related to mortality by a multivariate Cox proportional-hazards analysis. The Kaplan-Meier survival curves according to the median value of serum UA demonstrated that patients with high serum UA had a significantly higher mortality rate than did those with low serum UA (log-rank test, p < 0.01). These results suggest that serum UA increases in proportion to the clinical severity of PPH and has independent association with long-term mortality of patients with PPH.     

Significance of acute-phase inflammatory reactants as an indicator of prognosis after acute myocardial infarction: which is the most useful predictor?

OBJECTIVES: To investigate the relationship between representative acute-phase inflammatory reactants [highly sensitive C-reactive protein (hsCRP), serum amyloid A protein (SAA) and interleukin-6 (IL-6)] and the severity of acute myocardial infarction and patient prognosis, and to identify the most useful predictor of the three. METHODS: This study investigated 132 consecutive patients admitted within 8 hr of onset of first acute myocardial infarction and successfully reperfused with primary percutaneous coronary intervention. Acute-phase (= 24 hr from onset) blood samples were taken for evaluation of inflammatory reactants (hsCRP, SAA and IL-6), and peak creatine phosphokinase levels were measured every 4 hr after admission for 48 hr to assess myocardial infarction infarct size. Left ventriculography was performed in the chronic stage (20 +/- 9 days post-admission) to analyze left ventricular ejection fraction and regional wall motion, using Killip's classification to determine acute myocardial infarction severity. Logistic regression analysis was used to quantify the usefulness of the reactants as predictors of patient prognosis. RESULTS: Both hsCRP and SAA showed significant positive correlations with peak creatine phosphokinase. hsCRP and SAA showed significant inverse correlations with left ventricular ejection fraction and regional wall motion in the chronic stage. Multivariate analysis identified SAA as the best predictor of severe heart failure (Killip's classification III, IV). SAA was the best predictor of a major cardiac event (shock, cardiac death). CONCLUSIONS: These results suggest a strong correlation between acute-phase SAA and the clinical course of patient outcomes after acute myocardial infarction, such as cardiac function, heart failure and cardiac death. SAA may be the most useful acute-phase inflammatory reactant for predicting the prognosis after acute myocardial infarction.     

Serum uric acid levels as a predictor of in-hospital death in patients hospitalized for decompensated heart failure

OBJECTIVES: The aim of this study was to determine the value of serum uric acid levels in predicting in-hospital mortality of chronic heart failure patients hospitalized for decompensation in spite of appropriate medical therapy. METHODS AND RESULTS: This study was conducted in patients who were admitted to our clinic between January 2003 and April 2004 due to decompensated heart failure. Only patients who had a functional capacity of class IV and who already received loop diuretic and ACE inhibitor therapy before their admission were included. Patients with recurrent admissions during this period were excluded. Eighty-five patients fulfilled these criteria: group I consisted of 25 patients who died during hospitalization whereas group II consisted of 60 patients who were discharged alive after treatment. Age, sex, left ventricular ejection fraction derived from 2-D echocardiography, serum sodium (Na), gamma-glutamyl transpeptidase (GGT), creatinine, uric acid levels, white blood cell counts and drugs used on admission were the selected parameters as predictors of in-hospital mortality in these patients. When stepwise logistic regression analysis was used, female sex and serum uric acid levels at admission appear to be the only predictors of death during that hospitalization independent of other variables. CONCLUSIONS: Serum uric acid levels may be used as a predictor of death in hospitalized heart failure patients with class IV symptoms.     

TNF-α和IL-6检测在急性冠脉综合征发病中的意义

目的　探讨急性冠脉综合征患者血清TNF -α和IL -6的浓度与发病的关系。方法　选择急性冠脉综合征 (急性心肌梗死及不稳定心绞痛 )患者 3 6例 ,其中急性心肌梗死 7例 ,不稳定心绞痛患者 2 9例。根据不稳定心绞痛患者病情的严重程度将其按Braunwald分级分为三组 :Ⅰ级 9例 ;Ⅱ级 8例 ;Ⅲ级 12例。采用放免法测定急性冠脉综合征患者血清TNF -α和IL -6的浓度。结果　不稳定心绞痛患者由Ⅰ级组到Ⅲ级组随病情加重IL -6的浓度是逐渐升高的(P <0 .0 5 ) ,但血清TNF -α无明显升高 ;急性心肌梗死患者血清IL -6浓度在心梗发作后 6小时和 48小时有两个高峰 ,血清TNF -α在心梗发作后 2 4小时达到高峰 ;IL -6和TNF -α与反映心肌损伤的酶CK -MB无直线相关性。结论　不稳定的心绞痛患者随着病情加重体内IL -6水平逐步升高 ;AMI患者发病过程中伴随IL -6和TNF -α的升高 ,但IL -6和TNF -α的动态曲线不同 ;IL -6和TNF -α浓度的升高与AMI的心肌损伤严重程度无关     

血清尿酸水平在慢性心力衰竭患者病程中的临床意义

目的 探讨血尿酸（UA）水平在慢性心力衰竭（CHF）患者病程中的意义.方法 260例CHF患者,按NYHA心功能分级分为Ⅱ、Ⅲ、Ⅳ级组,分别为82、80、98例;按UA水平分为UA正常组（144例）和UA增高组（116例）.所有入选患者入院时或急诊检查UA、肾功能、电解质、脑利钠肽（BNP）等项目;超声心动图测定心脏左室舒张末期内径（LVEDd）、左室后壁厚度（LVPWd）、室间隔厚度（IVSd）和左室射血分数（LVEF）,计算左心室质量指数（LVMI）.结果 心力衰竭患者血UA水平明显升高,发生率为44.6％.随着心功能损害的加重,高尿酸血症的发生率增加（x2=33.01,P＜0.01）,UA水平增高（F=15.853,P＜0.01）.血UA增高者LVEDd明显增大,LVMI增加,LVEF值显著降低,BNP明显上升（P＜0.01）.相关分析显示,LVMI与血UA水平呈正相关（r=0.295,P＜0.01）,LVEF与血UA水平呈负相关（r=-0.446,P＜0.01）,BNP与血UA水平呈正相关（r=0.404,P＜0.01）.结论 UA是CHF病变进展及严重程度的一个重要指标.     

Changes in uric Acid levels and allopurinol use in chronic heart failure: association with improved survival

ObjectiveUric acid (UA) levels are frequently increased in patients with heart failure (HF), and may be an indicator of a poor prognosis and an innovative target for treatment. We evaluated the effect of UA and allopurinol use on clinical outcome in patients with HF.Methods and ResultsWe evaluated patients with a diagnosis of HF at a Health Maintenance Organization (n = 6204). Patients were followed for cardiac-related hospitalizations and death. Mean UA levels were 6.5 ± 1.9 mg/dL. Median follow-up was 498 days. We divided patients into quartiles of serum UA; 22.6% (n = 1,568) were in the highest UA level quartile (>7.7 mg/dL). Cox regression analysis after adjustment for significant predictors including age, sex, ischemic heart disease, hypertension, atrial fibrillation, body mass index, hemoglobin, sodium, estimated glomerular filtration rate, urea levels, standard HF drug therapies, and allopurinol demonstrated that high UA levels (>7.7 mg/dL) were a predictor of increased mortality (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.17–1.60; P < .0001) and increased cardiac hospitalizations (HR 1.10, 95% CI 1.01–1.22; P < .05). An increase in UA levels during follow-up was also an independent predictor of mortality (HR 1.46, 95% CI 1.25–1.71; P < .00001) and cardiac hospitalizations (HR 1.15, 95% CI 1.06–1.23; P < .00001). Treatment with allopurinol was independently associated with improved survival (HR 0.79, 95% CI 0.64–0.98; P < .05). Echocardiographic data demonstrated a significant correlation between UA levels and E/A ratio, a marker of diastolic dysfunction.ConclusionsIncreased UA levels and an increase in UA during follow-up were independent predictors of increased morbidity and mortality. Treatment with allopurinol was associated with improved survival.     

和肽素对慢性心力衰竭患者预后的预测

目的 探讨血清和肽素（Copeptin）水平与慢性心力衰竭患者近期预后的关系.方法 入选160例心力衰竭患者,依照纽约心脏协会功能分级系统（NYHA）分为4组,心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级组各40例,对四组患者的一般临床资料、心脏超声数据、血清和肽素水平及1年内心血管事件发生率进行分析.再按随访1年内是否发生心血管事件分为事件组与非事件组,并对相关数据进行统计.结果 心衰患者血清和肽素水平与心功能严重程度密切相关（P＜0.05）.事件组和肽素水平高于非事件组（P＜0.05）.多因素logistic回归分析显示,和肽素水平、LVEF、和β受体阻滞剂的应用是预测心血管事件发生的危险因素,和肽素水平预测患者1年内发生心血管事件的ROC曲线下面积为0.887,95％的可信区间为0.834～0.939 （P＜0.05）.结论 和肽素水平作为一个新的心力衰竭标志物,可以评估心力衰竭患者的预后.     

急性冠状动脉综合征与血尿酸的相关性研究

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)与血尿酸的关系及ACS患者血尿酸升高的相关危险因素。方法选择ACS患者306例,根据诊断分为急性心肌梗死(acute myocardial infarction,AMI)组150例,不稳定性心绞痛(unstable angina pectoris,UAP)组156例。又根据血尿酸水平分为:A组(血尿酸<260.0μmol/L)102例、B组(血尿酸260.0～356.9μmol/L)127例、C组(血尿酸>356.9μmol/L)77例,另选择健康体检者160例作为对照组。观察各组年龄、性别、吸烟史、饮酒史、高血压史、脂肪肝情况、LVEF、血肌酐、尿素、TG、TC、HDL-C、LDL-C、糖化血红蛋白,采用logistic回归分析血尿酸升高的主要因素。结果 AMI组和UAP组血尿酸水平明显高于对照组,差异有统计学意义(P<0.05)。A组、B组、C组在性别、脂肪肝、LVEF、血肌酐和TG等方面差异有统计学意义(P<0.05)。logistic回归分析显示,尿素、血肌酐、TG是ACS患者血尿酸升高的危险因素。结论 ACS患者具有较高的高尿酸发生率,且尿素、血尿酸、TG水平升高可能为ACS患者发生高尿酸血症的重要原因。     

老年心力衰竭患者心功能与血浆B型钠尿肽和尿酸的相关性研究

目的探讨老年心力衰竭(CHF)患者心功能与血浆B型钠尿肽(BNP)和血尿酸的相关性。方法选择132例老年CHF患者作为CHF组,并按心功能分级(NYHA)Ⅰ级26例、Ⅱ级38例、Ⅲ级40例、Ⅳ级28例。同期选择健康体检者50例作为对照组。分别测定血浆BNP及血尿酸水平,比较不同心功能级别入选患者的血浆BNP水平和血尿酸水平。结果 CHF组患者血浆BNP和血尿酸水平明显高于对照组,差异有统计学意义[(784.19±206.00)ng/L vs(41.25±15.34)ng/L,(405.24±90.16)μmol/L vs(286.43±78.68)μmol/L,P<0.01];不同心功能分级患者血浆BNP和血尿酸水平两两比较,差异有统计学意义(P<0.05,P<0.01);CHF时,BNP与心功能分级、血尿酸、左心室舒张末内径(LVEDD)呈正相关(r=0.76、0.33、0.22,P<0.05);与LVEF呈负相关(r=-0.34,P<0.05);尿酸与心功能分级、LVEDD呈正相关(r=0.41、0.23,P<0.05);与LVEF呈负相关(r=-0.24,P<0.05)。结论血浆BNP和血尿酸水平与心功能分级可能具有相关性。     

急性心肌梗死近期并发症与血清肌钙蛋白I水平变化的关系

目的探讨急性心肌梗死(AMI)近期并发症与血清心肌肌钙蛋白I变化的关系。方法用固相免疫层析技术检测AMI患者发病第1、3、5和7天的血清心肌肌钙蛋白I水平。根据结果将106例AMI患者分为血清心肌肌钙蛋白I强阳性组、阳性组和弱阳性组,分析并比较三组患者住院期间的心力衰竭、心律失常、缺血性胸痛、心源性休克和心脏性死亡的发生情况。结果血清心肌肌钙蛋白I强阳性组和阳性组的心力衰竭、缺血性胸痛和心脏性死亡的发生率明显高于血清心肌肌钙蛋白I弱阳性组(P<0.01),但前两组之间的发生率差异无统计学意义(P>0.05),心律失常和心源性休克的发生率三组之间差异无统计学意义(P>0.05)。结论血清心肌肌钙蛋白I水平的变化情况可做为估计AMI近期并发症的发生和预后过程的重要参考依据。     

Association of serum uric acid change with mortality,renal function and diuretic dose administered in treatment of acute heart failure

Background and aims

Hyperuricemia is reportedly associated with poor outcome in acute heart failure (AHF). The association between changes in Uric acid (UA) levels with renal function change, diuretic doses, and mortality in patients with AHF were studied.

Serum soluble ST2 is a promising prognostic biomarker in HBV-related acute-on-chronic liver failure

BACKGROUND: The IL-33/ST2 axis is involved in the patho-genesis of many diseases such as autoimmune diseases, cancer, and heart failure. However, studies of the IL-33/ST2 pathway in HBV-related acute-on-chronic liver failure (HBV-ACLF) are lacking. The present study aimed to determine the prognostic role of serum IL-33/soluble ST2 (sST2) in HBV-ACLF.METHODS: Serum levels of IL-33 and sST2 in healthy controls (HC, n=18), chronic hepatitis B (CHB, n=27) and HBV-ACLF (n=51) patients at the 1st and 4th week after enrollment were detected using ELISA, and clinical data were collected. The follow-up of HBV-ACLF patients lasted for 6 months at least.RESULTS: There was no significant difference of serum IL-33 level among HC, CHB and HBV-ACLF patients at week 1. However, serum sST2 level differed significantly among the three groups: highest in the HBV-ACLF group, moderate in the CHB group and lowest in the HC group. There was a re-verse correlation between serum sST2 level and the survival of HBV-ACLF patients. The level of serum sST2 in HBV-ACLF survivors was significantly declined from week 1 to week 4 following the treatment, whereas that in HBV-ACLF non-survivors remained at a high level during the same period. Fur-thermore, serum sST2 level was significantly correlated with laboratory parameters and the most updated prognostic scores (CLIF-C OF score, CLIF-C ACLF score and ACLF grades). The receiver operating characteristics curves demonstrated that serum sST2 level was a good diagnostic marker for predicting the 6-month mortality in HBV-ACLF patients, comparable to the most updated prognostic scores. Serum sST2 cut-off points for predicting prognosis in HBV-ACLF patients were 76 ng/mL at week 1 or 53 ng/mL at week 4, respectively. HBV-ACLF pa-tients with serum sST2 level above the cut-off point often had a worse prognosis than those below the cut-off point.CONCLUSION: Serum sST2 may act as a promising biomark-er to assess severity and predict prognosis of patients with HBV-ACLF and help for the early identification and optimal treatment of HBV-ACLF patients at high risk of mortality.     

Elevated serum uric acid level was a notable adverse event during combination therapy with sofosbuvir and ribavirin

Aim

Combination therapy with sofosbuvir and ribavirin (SOF/RBV) has been recently available for chronic hepatitis C patients with genotype 2 (CHG2) in Japan. The domestic phase III clinical trial showed a high antiviral effect with a relatively safe adverse event (AE) profile. Our aim was to report an important AE detected during treatment.

Methods

A prospective multi‐institutional study of 12‐week combination therapy with SOF/RBV for CHG2 was carried out to evaluate efficacy and safety.

Results

The eligible subjects included 142 patients. Out of 50 assessable patients, 16% of the patients were diagnosed with hyperuricemia. The proportions of subjects with grade 1, grade 3, and grade 4 hyperuricemia were 12, 2, and 2%, respectively. Serum uric acid (UA) levels at week 1 of the therapy (W1) were numerically the highest during therapy in patients with hyperuricemia, and the ratio of W1/baseline serum UA levels was significantly higher than that of post‐treatment week 4 or 8/baseline serum UA levels in assessable patients. Serum UA levels at W1 were significantly correlated with body mass index. The difference between serum UA levels at W1 and baseline serum UA levels was significantly correlated with the difference between serum creatinine levels at W1 and baseline serum creatinine levels.

Conclusions

Elevated serum UA level was a notable AE associated with SOF/RBV therapy for CHG2. However, because of the small number of subjects, the exact frequency of AEs should be re‐evaluated with larger cohorts. We need to remember that elevated serum UA level might develop during the therapy, especially at W1.     

Tissue plasminogen activator on admission is an important predictor of 30-day mortality in patients with acute myocardial infarction undergoing primary angioplasty

Tissue plasminogen activator (tPA) is emerging as an important risk factor for coronary heart disease, but the association between tPA concentration and mortality in acute myocardial infarction (AMI) remains uncertain. We studied the relationship between tPA antigen level on admission and 30-day mortality in 226 consecutive patients with AMI undergoing primary angioplasty. Death within 30 days occurred in 13 patients (5.7%). The concentration of tPA was significantly higher among the 13 patients who died than among the 213 who survived (26.5+/-16.3 versus 12.5+/-8.5 ng/mL, p<0.001). Compared with those in the lowest quartile (<9 ng/mL), patients in the highest quartile (>16 ng/mL) had a relative risk of subsequent death of 13.1 (p=0.014). In a Cox regression model, a tPA concentration >19 ng/mL was independently associated with mortality (HR 12.1, 95% CI, 1.9-76.7, p=0.001). This cutoff value had a 76.9% sensitivity and an 85.9% specificity for predicting 30-day mortality. tPA concentration was also higher in patients with severe heart failure (20.9+/-14.2 ng/mL versus 11.7+/-7.5 ng/mL, p=0.001) or ventricular tachyarrhythmia (24.3+/-13.9 ng/mL versus 12.2+/-8.4 ng/mL, p=0.001). In conclusions, elevated tPA antigen at initial presentation in patients with AMI was associated with higher short-term risk of death, suggesting that tPA may be a useful prognostic biomarker for the early risk stratification of these patients.     

Serum level of uric acid, partly secreted from the failing heart, is a prognostic marker in patients with congestive heart failure.

BACKGROUND: A recent study suggested that xanthine oxidase is activated in congestive heart failure (CHF). However, whether uric acid (UA) is secreted from the failing heart remains unknown, so it is currently unclear whether serum UA can provide prognostic information independent of brain natriuretic peptide (BNP). METHODS AND RESULTS: Serum UA was measured in the aortic root (AO) and the coronary sinus (CS) of 74 patients with CHF. The serum UA level was significantly higher in the CS than in the AO. The transcardiac gradient of UA (CS-AO) increased with the severity of CHF, inversely correlated with left ventricular ejection fraction (LVEF) and positively correlated with left ventricular end-diastolic volume index. The plasma levels of norepinephrine, BNP, UA, and LVEF were monitored prospectively in 150 CHF patients for a mean follow-up of 3 years. High plasma levels of UA (p<0.001) and BNP (p<0.001) were shown by multivariate stepwise analysis to be independent predictors of mortality. CONCLUSIONS: High plasma UA level, partly secreted from the failing heart, is a prognostic predictor independent of BNP in patients with CHF. Monitoring a combination of BNP and UA may be useful for the management of patients with CHF.