Author + information
- Mesut Keçebaş1,
- Sümeyye Güllülü1,
- Saim Sağ1,
- Ebru Açıkgöz2,
- Feyzullah Beşli1,
- Tunay Şentürk1,
- Aysel Aydın Kaderli1,
- Bülent Özdemir1,
- İbrahim Baran1,
- Emre Sarandöl2 and
- Ali Aydınlar1
Activation of the immune system has been implicated in the pathogenesis of heart failure. Fetuin-A (α2-Heremans Schmid glycoprotein), as a negative acute-phase reactant, prevents the increase of inflammatory response of the body against it by increasing the cellular uptake of cationic inhibitors of proinflamatory cytokine synthesis. Fetuin-A levels in the blood were shown to be inversely associated with the proinflammatory cytokines such as IL-1 beta, IL-6 and TNF-alpha levels. In our study, it was aimed to evaluate the importance of serum fetuin-A levels in the diagnosis and assessment of left ventricular systolic heart failure and to compare with the level of serum CRP and pro-BNP.
We enrolled 66 patients with a diagnosis of heart failure and 31 patients without a diagnosis of heart failure forming a control group who admitted to the Department of Cardiology at Uludag University Medical Faculty, Bursa, between July 2011 to January 2012. After informed consent for biochemical examinations had been obtained, blood samples were collected from the controls and the patients with chronic heart failure. Both study and control group patients had detailed echocardiographic examination.
Median serum fetuin-A levels of the heart failure group were significantly lower than the control group (p<0,001) [respectively 72.94 (14.11 to 648.88) μg/ml, 526.36 (282.98 to 726.58) μg/ml]. Serum CRP and pro-BNP levels in the heart failure group were detected significantly higher than the control group (p<0.001). In all cases, fetuin-A levels positively correlated with left ventricular ejection fraction (EF) and negatively correlated with pro-BNP and CRP (respectively, r:0.732 p<0.001, r:-0.542 p<0.001, r:-0.352 p<0.001). ROC analysis was done for the serum fetuin-A, the area under the ROC curve was 96% and the ‘cut off’ level was determined as 270,45 ug / ml for fetuin-A giving a sensitivity of 86,36% and specificity of 96,77% for the diagnosis of the left ventricular heart failure (p<0,001).
In conclusion, our study is the first study as evidence for decreased serum fetuin-A levels in patients with left ventricular systolic heart failure. Serum fetuin-A was a diagnostic marker with high sensitivity and specificity for the patients with systolic heart failure and showed that it was as powerful marker as serum pro-BNP. However, due to a multifunctional protein, serum fetuin-A is affected by many factors. Prospective studies with larger sample sizes are needed to better clarify the diagnostic and prognostic role of fetuin-A in patients with heart failure.
|Patient group (n=66)||Control group (n=31)||p value|
|Age (years) (mean±SD)||62.27±14.84||60.70±6.85||0.113|
|Hypertension (n, %)||36 (54.5%)||19 (61.3%)||0.685|
|Smoking (n, %)||6 (9.1%)||4 (12.9%)||0.722|
|Obesity (n,%)||14 (21.2%)||12 (38.7%)||0.117|
|LVEF (%)||29.5(18-45)||65 (54-73)||<0.001|
|Creatinine (mg/dl)||0.9 (0.6-1.2)||0.7 (0.6-1.1)||<0.001|
|CRP (mg/L)||0.7 (0.3-19.7)||0.33 (0.3-0.68)||<0.001|
|Pro-BNP (μg/ml)||3442.5 (21.78-20806)||85.53 (18.16-184.10)||<0.001|
|Fetuin-A (μg/ml)||72.94 (14.11-648.88)||526.36 (282.98-726.58)||<0.001|
CRP: C-reactive protein, BNP: B-type natriuretic peptide, CRP: C-reactive protein, LVEF: left ventricular ejection fraction