Abstract 827: High Serum Level of Neopterin Is a Risk Factor of Patients with Heart Failure
Neopterin is produced by activated monocytes/macrophages, and serum neopterin concentrations reflect the level of oxidative stress. We assessed the hypothesis that serum neopterin is a risk factor for heart failure and predicts adverse clinical outcomes in patients with heart failure. Serum neopterin concentration was measured in 198 patients with heart failure and 62 control subjects by a competitive enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 745 days with end points of cardiac death or re-hospitalization due to progressive heart failure. Serum concentration of neopterin was significantly higher in New York Heart Association (NYHA) Class III/IV patients than in NYHA class I/II patients (P < .001). From the receiver operating characteristic (ROC) curve analysis, the cut-off value of serum neopterin level was determined as 10 nmol/L. Kaplan-Meier analysis clearly demonstrated that the high neopterin group had a significantly higher incidence of cardiac events than occurred in the low neopterin group (P < .0001). Patients were divided into 4 groups based on the serum neopterin levels, the highest 4th quartile was associated with the highest risk of cardiac events (11.1-fold compared with 1st quartile). In the multivariate Cox analysis, serum neopterin concentration was an independent risk factor for cardiac events (hazard ratio 1.70, 95% confidence interval 1.16–2.50, P = 0.0068). Serum neopterin concentration is an independent prognostic factor for heart failure, and may be useful for risk stratification of patients with heart failure.