Author + information
- Received October 17, 2006
- Revision received February 7, 2007
- Accepted February 8, 2007
- Published online June 19, 2007.
- W.H. Wilson Tang, MD, FACC⁎,⁎ (, )
- Wilson Tong, MSc⁎,
- Richard W. Troughton, MBBS†,
- Maureen G. Martin, RDCS⁎,
- Kevin Shrestha, AB⁎,
- Allen Borowski, RDCS⁎,
- Sue Jasper, BSN⁎,
- Stanley L. Hazen, MD, PhD, FACC⁎,1 and
- Allan L. Klein, MD, FACC⁎
- ↵⁎Reprint requests and correspondence:
Dr. W. H. Wilson Tang, Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195.
Objectives The purpose of this study was to explore the relationship between myeloperoxidase (MPO) and cardiac structure, performance, and prognosis.
Background Myeloperoxidase is an inflammatory marker that is elevated in patients with heart failure (HF) and cardiac dysfunction, with mechanistic links to plaque vulnerability and left ventricular (LV) remodeling.
Methods We evaluated plasma MPO levels (CardioMPO, PrognostiX, Inc., Cleveland, Ohio) in 140 patients with chronic systolic HF (LV ejection fraction <35%) and examined the plasma MPO levels’ relationships with echocardiographic indexes of systolic and diastolic performance, as well as long-term clinical outcomes (death, cardiac transplantation, or HF hospitalization).
Results Within the overall cohort, increasing plasma MPO levels were associated with increasing likelihood of more advanced HF (restrictive diastolic stage, right ventricular systolic dysfunction ≥3+, and tricuspid regurgitation area ≥1.8 cm2). Plasma MPO levels were predictive of long-term clinical outcomes (risk ratio [95% confidence interval] = 3.35 [1.52 to 8.86]), even after adjustment for age, LV ejection fraction, plasma B-type natriuretic peptide (BNP), creatinine clearance, or diastolic stage. In receiver-operator characteristic curve analyses, addition of MPO to BNP testing augmented the predictive accuracy of future adverse clinical events (area under the curve 0.66 for BNP only [chi-square test = 12.9, p = 0.0003], and 0.70 for BNP plus MPO [chi-square test = 15.87, p = 0.0004]).
Conclusions In chronic systolic HF, elevated plasma MPO levels are associated with an increased likelihood of more advanced HF. Moreover, elevated plasma MPO levels within a HF subject seem to be predictive of increased adverse clinical outcomes.
↵1 Dr. Hazen is named as co-inventor on pending patents filed by the Cleveland Clinic Foundation that relate to the use of biomarkers to inflammatory and cardiovascular diseases. Dr. Hazen is the scientific founder and a consultant to PrognostiX Inc. Dr. Hazen has received honoraria and consulting fees from PrognostiX Inc. and Biosite, Inc.
The ADEPT study was supported by the 2003 American Society of Echocardiography Outcomes Research Award (Drs. Troughton and Klein) and by GlaxoSmithKline Pharmaceuticals. This work on myeloperoxidase in the ADEPT study was supported by National Institutes of Health grants P01 HL076491, P01 HL77107, and HL70621; the American Heart Association Ohio Valley Affiliates (0465266B); and the Cleveland Clinic Foundation General Clinical Research Center (M01 RR018390). Drs. Hazen and Tang have received research grant support from Abbott Diagnostics, Inc. Margaret Redfield, MD, acted as the Guest Editor for this article.
- Received October 17, 2006.
- Revision received February 7, 2007.
- Accepted February 8, 2007.
- American College of Cardiology Foundation