Abstract 14681: Circulating Levels of the Fibrosis Marker Syndecan-1 Predict Outcome in Heart Failure With Preserved Ejection Fraction
Aims: Syndecan-1 (sdc1) is a member of the proteoglycan family involved in cell-matrix interactions. Experimental studies showed that sdc1 is associated with inflammation in acute myocardial infarction and remodeling. Its role in human heart failure (HF) is unknown.
Methods and results: We analyzed plasma Sdc1 levels in a cohort of 571 HF patients. The primary endpoint was a combination of all-cause mortality and re-hospitalization for HF at 18 months. The secondary endpoint was all-cause mortality at 3 years. Mean age was 71.0 ± 11.0 year, 38% were female, and mean LVEF was 32.4 ± 14.0%. Median sdc1 levels were 20.1 ng/mL (IQR 13.9 - 27.7 ng/mL). Multivariable regression and bootstrap analyses showed a strong positive correlation of sdc1 levels with systolic blood pressure (p=0.009) and markers of fibrosis and remodeling (galectin-3 and ST-2, both p<0.001), but no correlation with inflammation markers (hsCRP and IL-6). During follow up, 240 patients reached the combined endpoint at 18 months and 234 patients had died after 3 years. A doubling of Sdc1 levels was associated with an impaired outcome, however significance was lost in the multivariable correcting for NT-proBNP levels and left ventricular ejection fraction (LVEF). Interaction analysis revealed a significant interaction between LVEF and sdc1 for both the primary (p = 0.018) and secondary endpoint (p = 0.004). Only in patients with a preserved LVEF (>40%) sdc1 levels per doubling were predictive for both the primary (HR: 1.55, 95% CI 1.11-2.16, p = 0.009) and secondary endpoint (HR: 1.96, 95% CI 1.37-2.81, p<0.001) in multivariable analyses.
Conclusions: Sdc1 is an independent marker for outcome in HF with preserved LVEF but not in reduced LVEF. Sdc1 levels strongly correlated with other fibrosis markers pointing towards a role in cardiac fibrosis and remodeling.
- © 2013 by American Heart Association, Inc.