Abstract 18854: Markers of Bone Metabolism and Cardiovascular Mortality in Ischaemic Cardiomyopathy
Background: In patients with ischaemic cardiomyopathy high rates of fracture related mortality have been reported. A growing body of evidence suggests a complex interaction between heart failure, congestion, limited physical activity and bone health. More so, recent studies showed that increased markers of bone metabolism, i.e. Beta CrossLaps (CTX) and Osteocalcin (OC), are associated with reduced LV systolic function and increased LV stiffness. Nevertheless, whether CTX and OC are associated with cardiovascular (CV) mortality and pro-brain-natriuretic peptide levels (proBNP) in ischaemic cardiomyopathy is still debated.
Methods: We analysed participants of a prospective cohort study of patients referred to coronary angiography at a tertiary care centre in Germany between 1997 and 2000. Indications for coronary angiography were based on clinical routine, most commonly chest pain, dyspnoea or second to non-invasive tests. For the current analysis only patients with an LV-EF < 50% and 2- or 3-vessel coronary artery diseases were included. We used a multivariate Cox proportional hazard analysis adjusting for traditional CV risk factors and medication use to investigate the association between CTX and OC with CV mortality.
Results: A total of 711 participants (64.6±9.96 years; 17.8% females; median follow-up 9.5 years) were included in the analyses. Mean LV-EF was 44.2±15.2%, 26.9% had previously an aorto-coronary bypass grafting, median New York Heart Association functional class was 2 (IQR=1-3). A significant correlation between proBNP and OC (r=0.103;P=0.003), as well as CTX (r=0.170;P≤0.001) was found. Multivariate Cox proportional hazard analysis revealed an increased risk for CV mortality for higher CTX concentrations (HR=3.29 95%CI [1.98 - 5.47]; P<0.001) but not for OC (HR=1.15 95%CI [0.97 - 1.37]; P=0.103).
Conclusion: In patients with ischaemic cardiomyopathy markers of bone metabolism and especially resorption were associated with increased proBNP levels and long-term CV mortality. More interventional data on improvement of systolic function with regard to bone metabolism and fracture rates are needed to clarify their role.
Author Disclosures: M.R. Grubler: None. N. Verheyen: None. J. Schmid: None. A. Fahrleitner-Pammer: None. L. Räber: None. A. Tomaschitz: None. S. Pilz: None. W. März: None.
- © 2016 by American Heart Association, Inc.