Abstract 14245: Serum Surfactant Protein-D is a Useful Marker Reflecting Pulmonary Congestion in Patients with Heart Failure
Background: Previous study have shown pulmonary edema causes alveolar-capillary barrier damage and induces leakage of pulmonary surfactant proteins into the plasma. Although surfactant protein D (SP-D) has been frequently used as well-established marker of active interstitial pneumonia, there is little information about the relationship between levels of SP-D and heart failure (HF). This study was designed to investigate whether levels of SP-D reflect pulmonary congestion and are associated with the prognosis of patients with HF.
Methods and Results: We measured serum SP-D in 40 control subjects and 134 patients with HF (mean age: 70±11 years, male: 63%). Serum SP-D concentrations were significantly correlated with mean pulmonary capillary wedge pressure and mean pulmonary artery pressure, suggesting elevated serum SP-D reflects the degree of pulmonary congestion. Next, total of 134 patients were prospectively followed during a median follow-up period of 226 days with end points of cardiac death or rehospitalization for worsening heart failure. Serum SP-D and plasma brain natriuretic peptide (BNP) were significantly higher in patients with cardiac events than in those without events (P<0.05, P<0.01, respectively). In view of the fact that BNP is secreted as a result of myocardial stretch, we divided patients into three groups according to a ROC-derived cut off value of BNP (233.8 pg/ml) and SP-D (84.1 ng/ml) : Group 1 (low BNP), Group 2 (high BNP, low SP-D), Group 3 (high BNP, high SP-D). Kaplan-Meier analysis clearly demonstrated that the Group 3 had a significantly higher incidence of cardiac events than other groups (P=0.0025). In the multivariate Cox analysis, serum SP-D level was an independent risk factor for cardiac events (hazard ratio 1.71, 95% confidence interval 1.05–2.0, P<0.05).
Conclusions: Serum SP-D reflects pulmonary congestion and may provide an additional information regarding therapeutic options in HF patients.
- © 2010 by American Heart Association, Inc.