Elevated Cystatin C Predicts Long-Term Adverse Cardiac Events in Patients with Heart Failure Independent of Natriuretic Peptide Levels and Creatinine Clearance

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Journal of Cardiac Failure


Background: Cystatin C is a cysteine protease inhibitor that has been broadly accepted as a sensitive marker of glomerular filtration rate. The prognostic role of cystatin C has been described in both acute and chronic heart failure settings, but its ability to predict adverse long-term outcomes independent of B-type natriuretic peptide (BNP) has not been extensively explored. Methods: We evaluated cystatin C levels in a large cohort of stable patients with history of heart failure undergoing coronary angiography. Cystatin C and BNP levels were measured using the Abbott Architect ci8200 platform. Major adverse cardiac events (MACE 5 death, myocardial infarction, stroke) were followed prospectively over the course of 3 years. Results: In our study cohort (n5823, mean age 67611 years, 61% male, median BNP 300 pg/mL, 75% with preserved creatinine clearance [O60 mg/mL]), median cystatin C level was 1.11 mg/L (interquartile range 0.92-1.41 mg/L). There was modest correlation between cystatin C and BNP levels (Spearman’s r 5 0.34, p!0.001). In Cox proportional hazard analyses, cystatin C (per standard deviation increments) was predictive of future MACE at 3 years even after adjustments for BNP (Hazard ratio 1.20, 95% confidence interval 1.08-2.34, p!0.0009). This is particularly robust in the subset with preserved creatinine clearance Hazard ratio 1.68, 95% confidence interval 1.05-2.63, p50.03, n5615). Conclusion: Elevated cystatin C levels predict future adverse cardiac events independent of natriuretic peptide levels in stable patients with heart failure, particularly in those with underlying preserved renal function.


Abstract only (#072). Presentation at the 15th Annual Scientific Meeting of the Heart Failure Society of America, Boston, MA., Sept. 18 -21, 2011.