Abstract 3562: High Serum Level of Neopterin Predicts Cardiac Events in Chronic Heart Failure Patients With Preserved Left Ventricular Systolic Function
Background: More than 40% of patients hospitalized with heart failure have preserved left ventricular ejection fraction (LVEF) and are at high risk for cardiac events. The purpose of this study was to determine the value of Neopterin in predicting adverse outcomes in patients with preserved LVEF. Neopterin is produced by activated monocytes/macrophages, and serum neopterin concentrations reflect the level of oxidative stress.
Methods and Results: Serum neopterin concentration was measured in 132 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 691 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 functional class (P<0.0001). Kaplan-Meier analysis clearly demonstrated that the high neopterin group (>10 nmol/L) had a significantly higher incidence of cardiac events than the low neopterin group (P<0.0001). Patients were divided into 3 groups based on the serum neopterin levels, and the highest 3rd tertile was associated with the highest risk of cardiac events (7.64-fold compared to the 1st tertile). In the multivariate Cox analysis, serum neopterin concentration was an independent risk factor for cardiac events (hazard ratio 2.03, 95% confidence interval 1.29 –3.22, P=0.0023).
Conclusions: Serum neopterin concentration is an independent prognostic factor and may be useful for risk stratification of heart failure patients with preserved LVEF.