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Prognostic value of homocysteinemia in patients with congestive heart failure

Pierre Gibelin1, Stephanie Serre, Mirande Candito

  • 1Cardiology Department, Hôpital Pasteur, Nice, France. gibelinp@cote-dazur.com

Clinical Chemistry and Laboratory Medicine
|June 17, 2006
PubMed

Insights

Elevated homocysteine levels predict mortality in congestive heart failure (CHF) patients. Higher homocysteine is linked to increased disease severity and poorer prognosis, regardless of heart disease origin.

Area of Science:

  • Cardiology
  • Clinical Biochemistry
  • Vascular Medicine

Background:

  • Elevated plasma homocysteine is linked to vascular disease and congestive heart failure (CHF).
  • Hyperhomocysteinemia is a known risk factor for cardiac dysfunction.
  • The prognostic value of homocysteine in CHF requires further investigation.

Purpose of the Study:

  • To investigate the predictive value of elevated homocysteine levels in the prognosis of ischemic and non-ischemic CHF.
  • To assess the relationship between homocysteine levels and CHF severity.
  • To determine if hyperhomocysteinemia predicts mortality in CHF patients.

Main Methods:

  • 159 CHF patients (89 non-ischemic, 70 ischemic) and 119 controls underwent fasting blood tests for homocysteine, vitamin B12, and folate.
  • Coronary angiography was performed for all CHF patients.
  • Follow-up duration averaged 49.6 months.

Main Results:

  • Mean homocysteine levels were significantly higher in CHF patients (15.80 µmol/L) than controls (10.90 µmol/L) (p=0.001).
  • Homocysteine levels correlated positively with NYHA classification, creatinine, and age.
  • Hyperhomocysteinemia (RR 4.23, p=0.0003) was a powerful predictor of mortality in CHF patients, with 41.5% mortality in those with levels >17 µmol/L vs. 21.3% in those with levels <17 µmol/L.

Conclusions:

  • Elevated homocysteine levels in CHF patients correlate with disease severity, irrespective of etiology.
  • Hyperhomocysteinemia is a significant predictor of mortality in patients with congestive heart failure.
Abstract

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