Leptin: a parameter of metabolic changes in congestive heart failure

Objective Advanced chronic heart failure is a hypercatabolic state with an imbalance between anabolic and catabolic metabolism and finally progressive loss of both muscle mass and adipose tissue. Leptin, the product of the ob esity gene, is a hormone secreted by adipocytes. Therfore, we tested the hy pothesis that plasma leptin concentrations are reduced in advanced chronic heart failure. Methods In 20 patients with chronic congestive heart failure (LVEF 23 +/- 6%) and 20 healthy controls (LVEF 65 +/- 8%) matched for gend er, age, and body mass index, fasting plasma leptin (ELISA) and TNF alpha ( ELISA) were measured. Follow-up examination was performed after 1 year. Res ults The fasting plasma leptin concentrations of patients with NYHA grade I II(8.4+/-3.8 ng/ml*) and NYHA grade IV (4.6 +/- 2.4 ng/ml dagger) were sign ificantly lower as compared with the controls (11.2+/-3.1 ng/ml; * p < 0.05 , <dagger> p < 0.01). In patients with NYHA grade II plasma leptin levels w ere significantly elevated as compared with the healthy controls (14.9 +/- 4.2 ng/ mi). TNF<alpha>. was higher in heart failure patients than in healt hy controls (8.6 +/- 3.6 pg/ml; 5.9 +/- 2.1 pg/ml; respectively; p<0.05), b ut did not correlate with the NYHA functional class. Mortality of the contr ols was 0%, whereas 15% (n=3) in the congestive heart failure group; one pa tient (5%) needs an urgent heart transplantation. All of those patients had leptin concentrations below 5 ng/ mi. Conclusions Plasma leptin concentrat ions correlate with the NYHA functional class suggesting anabolic metabolis m in NYHA class II and catabolic metabolism in advanced heart failure which might be of prognostic relevance.