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Elevated serum cobalamin in patients with decompensated biventricular failure
Haris Zafarullah1, Atta U Shahbaz, Ragheed Alturkmani
1Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
The American Journal of the Medical Sciences
|November 18, 2008
Summary
Elevated vitamin B12 and bilirubin levels in patients with biventricular heart failure may indicate liver dysfunction without cell damage. Brain natriuretic peptide levels did not show congestion.
Area of Science:
- Cardiology
- Hepatology
- Biomarkers
Background:
- Serum vitamin B12 (cobalamin) is transported via transcobalamin II and taken up by hepatic vasculature endothelium.
- Hepatic congestion is hypothesized to elevate serum B12 without causing hepatocyte necrosis.
Purpose of the Study:
- To investigate the association between biventricular heart failure, hepatic congestion, and serum biomarkers.
- To determine if elevated serum cobalamin and bilirubin can serve as biomarkers for hepatocellular dysfunction and cholestasis in heart failure patients.
Main Methods:
- Serum levels of cobalamin, transaminases, bilirubin, and brain natriuretic peptide (BNP) were measured in 91 hospitalized patients.
- Patients were categorized into three groups: decompensated biventricular failure, acute left heart failure, and no clinical heart failure.
Main Results:
- Serum cobalamin was significantly elevated in patients with biventricular failure (861.4 pg/mL) compared to other groups (P < 0.0001).
- Bilirubin levels were increased in biventricular failure patients (1.8 mg/dL; P < 0.05), while transaminases remained normal.
- Plasma BNP was elevated across all groups, failing to distinguish systemic venous congestion.
Conclusions:
- Elevated cobalamin and bilirubin are potential biomarkers for hepatocellular dysfunction and cholestasis in decompensated biventricular failure.
- These biomarkers are indicative of congestion-related liver changes rather than direct hepatocyte necrosis.
- Elevated BNP is not a reliable indicator of systemic venous congestion in this patient population.
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