Abstract 2994: High Serum Level of Neopterin is a Risk Factor of Patients With Heart Failure
Background: Renal insufficiency is recognized as a predictor of mortality and poor outcome in heart failure patients. Neopterin is excreted from the organism in an unchanged form through the kidneys. Serum neopterin concentrations reflect the renal insufficiency and the level of oxidative stress. We assessed the hypothesis that serum neopterin is a more powerful predictor of adverse clinical outcomes in patients with heart failure than existing biomarkers.
Methods and Results: Serum neopterin concentration was measured in 238 patients with heart failure and 62 control subjects by the competitive enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 692 days with end points of cardiac death or re-hospitalization due to progressive heart failure. Serum concentration of neopterin increased with advancing New York Heart Association (NYHA) functional class (P<0.001). Serum neopterin concentration was significantly correlated with estimated GFR (R=0.448, P <0.0001) and BNP (R=0.469, P <0.0001). Although BNP concentration had very weak correlation with estimated GFR (R=0.269, P <0.0001). In the univariate Cox analysis, age, NYHA functional class, uric acid, creatinine, estimated GFR, sodium, BNP, neopterin and LVEDD were significantly associated with cardiac events. In the multivariate Cox analysis, serum neopterin concentration was an independent risk factor for cardiac events (hazard ratio 7.95, 95% CI 3.27–19.35, P<0.0001).
Conclusions: Serum neopterin concentration is an independent prognostic factor for heart failure, and may be useful for risk stratification of patients with heart failure.