Cw. Lee et al., Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure, CIRCULATION, 103(23), 2001, pp. 2784-2787
Citations number
12
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background - Cerebral metabolic abnormalities were proposed as a potential
marker of disease severity in congestive heart failure (CHF), but their pro
gnostic significance remains uncertain.
Methods and Results - We investigated the prognostic value of cerebral meta
bolic abnormalities in 130 consecutive patients with advanced CHF (100 men
aged 42.6 +/- 11.9 years; left ventricular ejection fraction, 22.2 +/-6.2%)
. Proton magnetic resonance spectroscopy data were obtained from localized
regions (approximate to8 mt) of the occipital gray matter and the parietal
white matter. The primary end point was the occurrence of death after the p
roton magnetic resonance spectroscopy. During follow-up (18.5 +/- 14.4 mont
hs), 21 patients died and 15 underwent urgent heart transplantation. In the
Cox proportional model, occipital metabolites (N-acetylaspartate, creatine
, choline, and myoinositol), parietal N-acetylaspartate level, and the dura
tion of CHF symptoms (> 12 months) were validated as univariate predictors
of death. In multivariate Cox analyses, however, the occipital N-acetylaspa
rtate level was an independent predictor of death (hazard ratio, 0.52; 95%
CI, 0.41 to 0.67; P <0.001), An analysis with respect to the combined end p
oint of death or urgent transplantation showed similar results. The best cu
toff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75% sens
itivity and 67% specificity to predict mortality.
Conclusions - The occipital N-acetylaspartate level is a powerful and indep
endent predictor of CHF mortality, suggesting that cerebral metabolic abnor
malities may be used as a new prognostic marker in the assessment of patien
ts with CHF.