Abstract 13339: Baseline Cystatin C is Associated with Short-Term Adverse Events in Acute Heart Failure but Does Not Predict Treatment Effects with Nesiritide Therapy
Background: Renal insufficiency is prevalent in acute decompensated heart failure (ADHF), and may affect the efficacy of loop diuretics. Predictive values of baseline and changes in cystatin C (cysC, a sensitive measure of renal function) for dyspnea status, short-term adverse outcomes, and response to nesiritide remain unknown.
Methods: cysC were measured in sequential plasma samples from 811 subjects with ADHF in ASCEND-HF biomarker sub-study (nesiritide versus placebo), and followed for 30 days for all-cause death or re-hospitalization.
Results: In our study cohort, median cysC values were 1.49 (IQR 1.20-1.96), 1.58 (IQR 1.28-2.13), and 1.58 (IQR 1.25-2.10) mg/L, at baseline, 48-72 hours, and 30 days respectively. Baseline cysC correlated with serum creatinine (r=0.70, p<0.01), and was similar in the nesiritide and placebo groups. Subjects with higher cysC were more likely to be older have associated coronary artery disease and diabetes mellitus, and higher blood urea nitrogen, and lower estimated glomerular filtration rates (eGFR). Higher cysC was associated with increased risk of 30-day adverse events (Table), but was not associated with change in dyspnea. There was no evidence of a differential treatment effect of nesiritide based on cysC (p value for interaction=0.67), and no difference in changes in cysC from baseline to 48-72 hours between nesiritide and placebo groups.
Conclusion: Our findings confirm the prognostic value of baseline cystatin C in predicting adverse events, but not dyspnea relief, in ADHF. These results also indicate nesiritide had no adverse effect on renal function as measured by cystatin C.
- © 2011 by American Heart Association, Inc.