Abstract 15702: Neutrophil Gelatinase-associated Lipocalin (NGAL) Correlates With Impaired Renal Function In Patients With Advanced Heart Failure And Corrects After Ventricular Assist Device Placement
Introduction: Patients with advanced heart failure (HF) develop progressive renal dysfunction. Novel renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) might improve the prognostic assessment of patients with HF. Our current study evaluated the role of NGAL in patients with advanced HF.
Methods: Serum samples were collected from 19 controls without HF (46.2±8.3 yrs, BMI 28.8±6.5 kg/m2), 39 patients with stable HF (60.8±9.8 yrs, BMI 28.6±4.4 kg/m2), and 39 HF patients undergoing ventricular assist device (VAD) implantation (53.5±12.6 yrs, BMI of 26.6±5.5 kg/m2) and VAD removal at cardiac transplantation (52.8±12.3 yrs, BMI 26.0±4.4, mean VAD duration 166±122 days). NGAL levels were measured by ELISA (R&D). Clinical data were collected from institutional medical records and eGFR calculated using the Modification of Diet in Renal Disease (MDRD) formula. Creatinine, eGFR and NGAL were correlated to clinical events including right ventricular failure (RVF) defined by the INTERMACS criteria.
Results: Patients with stable HF showed elevated NGAL levels compared to controls (109.9±35.6 ng/mL vs. 61.6±19.7 ng/mL, p<0.0001) which further increased in patients with advanced HF requiring VAD implantation (154.4±70.7 ng/mL, p<0.001). VAD implantation resulted in a decrease of NGAL levels (119.8±66.8 ng/mL, p<0.05). NGAL was elevated in patients who developed RVF compared to those without RVF (187.84±66.0 vs. 130.9±67.0 ng/mL, p=0.03) while creatinine and eGFR were not different between these two groups. Circulating levels of NGAL correlated with serum creatinine (r=0.29 p<0.01) and eGFR (r=-0.21, p<0.05).
Conclusion: NGAL levels correlate with HF severity and impairment of renal function as measured by serum creatinine and eGFR. Hemodynamic improvement after VAD placement decreases serum NGAL indicating the reversibility of renal dysfunction in advanced HF. Increased NGAL levels were associated with developing RVF following VAD, suggesting a role of this novel biomarker as a marker of severity and prognosis of HF. Therefore, NGAL proves to be a novel and sensitive biomarker of renal dysfunction and clinical events in patients with advanced HF.
- © 2011 by American Heart Association, Inc.