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Cystatin C in acute heart failure without advanced renal impairment

Hiroyuki Naruse1, Junnichi Ishii, Tomoko Kawai

  • 1Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.

The American Journal of Medicine
|April 28, 2009
PubMed

Insights

Cystatin C measurement improves early risk stratification in acute heart failure patients with mild renal impairment, outperforming the Modification of Diet in Renal Disease (MDRD) equation for predicting cardiac mortality.

Area of Science:

  • Cardiology
  • Nephrology
  • Biomarkers

Background:

  • Assessing renal function in acute heart failure (AHF) is crucial for risk stratification.
  • The prognostic value of cystatin C versus estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation in AHF patients with normal to moderate renal impairment remains understudied.
  • Improved detection of mild renal impairment may enhance risk stratification in these patients.

Purpose of the Study:

  • To investigate the prognostic value of cystatin C compared to eGFR (MDRD) in predicting cardiac mortality in AHF patients with preserved renal function.
  • To determine if cystatin C offers superior risk stratification compared to eGFR (MDRD) in this specific patient cohort.

Main Methods:

  • A cohort of 328 consecutive patients hospitalized for worsening chronic heart failure with eGFR (MDRD) ≥30 mL/min/1.73 m² were enrolled.
  • Cystatin C and creatinine levels were measured upon admission.
  • Patients were followed for a median of 915 days to ascertain cardiac deaths.

Main Results:

  • Cystatin C, but not eGFR (MDRD), was independently associated with cardiac mortality (P <.0001) in Cox regression analyses.
  • Kaplan-Meier and adjusted relative risk analyses indicated cystatin C better separated low-risk from high-risk patients.
  • Receiver-operating characteristic curve analyses demonstrated higher precision of cystatin C in predicting cardiac mortality.

Conclusions:

  • Cystatin C measurement may enhance early risk stratification in acute heart failure patients with normal to moderately impaired renal function.
  • Cystatin C appears to be a more precise predictor of cardiac mortality than eGFR (MDRD) in this population.
Abstract

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