Abstract 11499: Incremental Prognostic Significance of the Elevated Levels of Pentraxin 3 in Patients With Heart Failure With Normal Left Ventricular Ejection Fraction
Backgrounds: Pentraxin 3 (PTX3) is a novel inflammatory maker and produced by various cell types including vasculature and heart. We have shown that PTX3 is significantly elevated in patients with heart failure with normal left ventricular ejection fraction (HFNEF) and it is an independent inflammatory marker correlated with the presence of HFNEF. We investigate whether plasma levels of PTX3 could predict occurrence of future cardiovascular (CV) events in patients with HFNEF.
Methods: We conducted a prospective cohort study of 360 HFNEF patients (age 70.5±9.9, male 55.5%) with measuring plasma inflammatory markers (PTX3, high-sensitivity C-reactive protein [hsCRP], tumor necrosis factor-α and interleukin-6) and B-type natriuretic peptide (BNP) and followed CV events, which were a composite of CV death, non-fatal myocardial infarction or ischemic stroke, unstable angina, hospitalization for HF, or coronary revascularization.
Results: A total of 106 patients had a CV event. Kaplan-Meier analysis demonstrated significantly higher probability of CV events in the high-PTX3 group (>3.0ng/ml: median) than in the low-PTX3 group. In both low- and high-BNP group (85pg/ml: median), the high-PTX3 group had a significantly higher probability of CV events compared to the low-PTX3 group. Multivariate Cox hazard analysis with significant factors by univariate analysis identified PTX3 (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.05-1.27, P<0.01), and BNP (HR 1.09, 95%CI 1.04-1.14, P<0.001), but not hsCRP, as independent predictors of the future CV events. Multivariate Cox analysis with the forced inclusion model with the previously identified HFNEF prognostic five factors (PF5; age, diabetes, New York Heart Association class, HF hospitalization history, and LVEF) demonstrated PTX3 as the significant predictor (HR 1.16, 95%CI 1.05-1.27, P<0.01). The C-statistics for CV events substantially increased when PTX3 was added to HFNEF prognostic five factors (PF5-alone; 0.617 to PF5+BNP+PTX3; 0.683).
Conclusion: Elevated plasma levels of PTX3, but not other inflammatory markers including hsCRP, independently correlated with the future CV events in patients with HFNEF. PTX3 could provide incremental clinical information in patients with HFNEF.
- © 2013 by American Heart Association, Inc.