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Published on: June 10, 2025
The potential of cystatin-C to evaluate the prognosis of acute heart failure: A comparative study
Tae-Hun Kim1, Hyungseop Kim1, In-Cheol Kim1
1a Division of Cardiology, Department of Internal Medicine , Keimyung University Dongsan Medical Center , Daegu , Republic of Korea.
Insights
Cystatin-C (Cys-C) shows promise as a superior prognostic biomarker for acute heart failure (HF) patients, outperforming uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in predicting cardiac events.
Area of Science:
- Cardiology
- Biomarker Discovery
- Renal Function Assessment
Background:
- Prognosis in acute heart failure (HF) is linked to cardio-renal function.
- Cystatin-C (Cys-C) is a marker of cardio-renal function.
- Existing biomarkers like uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have limitations.
Purpose of the Study:
- To evaluate cystatin-C (Cys-C) as a prognostic indicator in acute heart failure (HF).
- To compare the prognostic utility of Cys-C against uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Main Methods:
- A cohort of 232 acute heart failure (HF) patients was studied.
- Measurements included Cys-C, UA, and NT-proBNP.
- Cardiac events (recurrent HF, cardiac death) were tracked over two years.
Main Results:
- Higher levels of Cys-C, UA, and NT-proBNP were observed in patients with cardiac events.
- Cys-C demonstrated a persistent hazard ratio over two years.
- Multivariate analysis identified Cys-C, TVI-Sm, and beta-blockers as significant predictors of adverse events.
- Cys-C provided incremental prognostic value beyond NT-proBNP and UA.
Conclusions:
- Cystatin-C (Cys-C) is a more effective prognostic biomarker for cardiac events in acute heart failure (HF) patients compared to UA and NT-proBNP.
- Cys-C aids in predicting long-term outcomes in acute HF.
Background:
The prognosis of acute heart failure (HF) can be determined by cardio-renal function which is assessed by cystatin-C (Cys-C). We evaluated whether Cys-C could be a more useful prognostic indicator in acute HF, compared with uric acid (UA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Methods:
Two hundred thirty-two HF patients in the emergency room were studied using measurements of Cys-C, UA, and NT-proBNP. During the follow-up, cardiac events, defined as the composites of recurrent HF or cardiac death, were determined.
Results:
Seventy-seven cardiac events (28 cardiac deaths, 49 recurrent HFs) occurred over two years. The events group revealed higher levels of Cys-C, UA, and NT-proBNP. They showed increased blood urea nitrogen and creatinine, reduced septal tissue Doppler velocity (TVI-Sm), and low frequencies of beta-blockers (BB), diuretics and angiotensin-converting enzyme inhibitors/-receptor blockers. Cys-C (the best cutoff: 1.7 mg/l) had a steady, persistent hazard ratio (HR) over two years. On multivariate analysis, Cys-C, TVI-Sm, and BB were significant predictors for adverse events. Cys-C provided an incremental value for prognosis more than NT-proBNP and UA did over the follow-up period.
Conclusions:
Compared with UA and NT-proBNP, Cys-C could be better prognostic biomarker for cardiac events two years after acute HF.
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