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Cystatin C identifies patients with stable chronic heart failure at increased risk for adverse cardiovascular events.
Circ Heart Fail. 2012 Sep 01; 5(5):602-9.CH

Abstract

BACKGROUND

Renal function is a strong predictor of adverse events in heart failure. Current renal function measures are imperfect, and cystatin C (CysC) is promoted as a better marker of glomerular filtration rate. This study compares the prognostic use of CysC and derived glomerular filtration rate estimates with other measures of renal function in patients with chronic heart failure.

METHODS AND RESULTS

We measured serum CysC levels in 823 patients with heart failure undergoing coronary angiography with follow-up of major adverse cardiovascular events (death, myocardial infarction, stroke). CysC levels strongly correlated with creatinine (r=0.73), blood urea nitrogen (r=0.70), and estimated glomerular filtration rate by the 4-variable modification of diet in renal disease equation (r=-0.62) (all P<0.001). However, the correlation was lower in estimated glomerular filtration rate ≥60 mL/min per 1.73 m(2). CysC-based measures significantly improved areas under the receiver operating characteristic curve for the prediction of major adverse cardiovascular events, especially in estimated glomerular filtration rate ≥60 mL/min per 1.73 m(2) (P<0.01). Net reclassification improvement was 22.2% (P<0.001) in this group. CysC remained an independent predictor of major adverse cardiovascular events (P<0.001) after adjustment for traditional risk factors and brain natriuretic peptide.

CONCLUSIONS

CysC is an independent predictor of adverse events in chronic heart failure. It adds prognostic value to creatinine, particularly in patients with preserved renal function.

Authors+Show Affiliations

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22899766

Citation

Dupont, Matthias, et al. "Cystatin C Identifies Patients With Stable Chronic Heart Failure at Increased Risk for Adverse Cardiovascular Events." Circulation. Heart Failure, vol. 5, no. 5, 2012, pp. 602-9.
Dupont M, Wu Y, Hazen SL, et al. Cystatin C identifies patients with stable chronic heart failure at increased risk for adverse cardiovascular events. Circ Heart Fail. 2012;5(5):602-9.
Dupont, M., Wu, Y., Hazen, S. L., & Tang, W. H. (2012). Cystatin C identifies patients with stable chronic heart failure at increased risk for adverse cardiovascular events. Circulation. Heart Failure, 5(5), 602-9.
Dupont M, et al. Cystatin C Identifies Patients With Stable Chronic Heart Failure at Increased Risk for Adverse Cardiovascular Events. Circ Heart Fail. 2012 Sep 1;5(5):602-9. PubMed PMID: 22899766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cystatin C identifies patients with stable chronic heart failure at increased risk for adverse cardiovascular events. AU - Dupont,Matthias, AU - Wu,Yuping, AU - Hazen,Stanley L, AU - Tang,W H Wilson, Y1 - 2012/08/16/ PY - 2012/8/18/entrez PY - 2012/8/18/pubmed PY - 2012/12/10/medline SP - 602 EP - 9 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 5 IS - 5 N2 - BACKGROUND: Renal function is a strong predictor of adverse events in heart failure. Current renal function measures are imperfect, and cystatin C (CysC) is promoted as a better marker of glomerular filtration rate. This study compares the prognostic use of CysC and derived glomerular filtration rate estimates with other measures of renal function in patients with chronic heart failure. METHODS AND RESULTS: We measured serum CysC levels in 823 patients with heart failure undergoing coronary angiography with follow-up of major adverse cardiovascular events (death, myocardial infarction, stroke). CysC levels strongly correlated with creatinine (r=0.73), blood urea nitrogen (r=0.70), and estimated glomerular filtration rate by the 4-variable modification of diet in renal disease equation (r=-0.62) (all P<0.001). However, the correlation was lower in estimated glomerular filtration rate ≥60 mL/min per 1.73 m(2). CysC-based measures significantly improved areas under the receiver operating characteristic curve for the prediction of major adverse cardiovascular events, especially in estimated glomerular filtration rate ≥60 mL/min per 1.73 m(2) (P<0.01). Net reclassification improvement was 22.2% (P<0.001) in this group. CysC remained an independent predictor of major adverse cardiovascular events (P<0.001) after adjustment for traditional risk factors and brain natriuretic peptide. CONCLUSIONS: CysC is an independent predictor of adverse events in chronic heart failure. It adds prognostic value to creatinine, particularly in patients with preserved renal function. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/22899766/Cystatin_C_identifies_patients_with_stable_chronic_heart_failure_at_increased_risk_for_adverse_cardiovascular_events_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.112.966960?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -