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Association between cystatin C and heart failure with preserved ejection fraction in elderly Chinese patients

Zusammenhang zwischen Cystatin C und Herzinsuffizienz mit erhaltener Ejektionsfraktion bei älteren chinesischen Patienten

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An Erratum to this article was published on 19 July 2016

This article has been updated

Abstract

Background

Approximately 50 % of patients with heart failure have a preserved ejection fraction (HFpEF). Cystatin C has been reported to be associated with cardiovascular events. This study was carried out to investigate whether cystatin C is associated with cardiac function and cardiac diastolic properties in elderly Chinese HFpEF patients.

Material and methods

A cross-sectional study of 381 elderly Chinese HFpEF patients (81 women, average age 82 ± 6 years) was conducted. Serum concentrations of cystatin C and the New York Heart Association (NYHA) classification were assessed and early (E) to late (A) transmitral flow velocity ratios (E/A ratio) were measured to assess cardiac diastolic properties.

Results

Cystatin C levels, N‑terminal pro brain natriuretic peptide (NT-proBNP) levels and age were significantly correlated to the NYHA class (r = 0.605 P < 0.001, r = 0.333 P < 0.001 and r = 0.254 P < 0.001, respectively). Cystatin C levels, age and body mass index (BMI) were negatively correlated to the E/A ratio (r = −0.224 P = 0.005, r = −0.258 P = 0.001 and r = −0.258 P = 0.003, respectively). The patients with cystatin C concentrations below 1.3 mg/l had a higher E/A ratio compared to those with cystatin C concentrations higher than 1.3 mg/l. Cystatin C was also significantly associated with both the NYHA classification and the E/A ratio even after adjustment for the creatinine clearance rate (CCr).

Conclusion

Both cystatin C and NT-proBNP were found to be correlated to the NYHA classification. Independent of renal function, higher serum concentrations of cystatin C were associated with a worse NYHA classification and abnormal cardiac diastolic properties in elderly Chinese HFpEF patients.

Zusammenfassung

Hintergrund

Bei etwa 50 % der Patienten mit Herzinsuffizienz ist die Ejektionsfraktion erhalten („heart failure with preserved ejection fraction“ [HFpEF]). Ein Zusammenhang von Cystatin C mit kardiovaskulären Ereignissen ist in der Literatur dokumentiert. In der vorliegenden Studie wurde überprüft, ob Cystatin C bei älteren chinesischen HFpEF-Patienten mit der Herzfunktion und mit diastolischen kardialen Eigenschaften assoziiert ist.

Material und Methoden

Mit 381 älteren chinesischen HFpEF-Patienten (81 Frauen, Durchschnittsalter 82 ± 6 Jahre) wurde eine Querschnittsstudie durchgeführt. Die Serumkonzentration von Cystatin C und das New-York-Heart-Association(NYHA)-Stadium wurden ermittelt, des Weiteren wurde zur Beurteilung der diastolischen kardialen Eigenschaften das Verhältnis der frühen (E) zur späten (A) transmitralen Flussgeschwindigkeit (E/A-Verhältnis) gemessen.

Ergebnisse

Die Cystatin-C-Konzentrationen, die Spiegel des N‑terminalen natriuretischen Vorläuferpeptids vom B‑Typ (NT-proBNP) und das Alter korrelierten signifikant mit dem NYHA-Stadium (r = 0,605, p < 0,001; r = 0,333, p < 0,001 bzw. r = 0,254, p < 0,001). Die Cystatin-C-Konzentrationen, das Alter und der Body-Mass-Index (BMI) korrelierten negativ mit dem E/A-Verhältnis (r = −0,224, p = 0,005; r = −0,258, p = 0,001 bzw. r = −0,258, p = 0,003). Die Patienten mit einer Cystatin-C-Konzentration unter 1,3 mg/l hatten ein höheres E/A-Verhältnis als solche mit einer Konzentration über 1,3 mg/l. Der signifikante Zusammenhang von Cystatin C mit dem NYHA-Stadium und dem E/A-Verhältnis hatte auch nach Adjustierung für die Kreatininclearance Bestand.

Schlussfolgerung

Wie die Untersuchungen ergeben haben, korrelieren Cystatin C und NT-proBNP mit dem NYHA-Stadium. Unabhängig von der Nierenfunktion waren höhere Serumkonzentrationen von Cystatin C bei älteren chinesischen HFpEF-Patienten mit einem schlechteren NYHA-Stadium und mit abweichenden diastolischen Eigenschaften des Herzens assoziiert.

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Change history

  • 19 July 2016

    An erratum to this article has been published.

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Funding

Open access funding provided by Grants from the science project of the Shanghai Jiaotong University affiliated Shanghai Sixth People’s Hospital, China.

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Authors and Affiliations

  1. Department of Geriatrics, Shanghai Jiaotong University affiliated Shanghai Sixth People’s Hospital, 600 Yishan Road, 200233, Xuhui District, Shanghai, China

    C. C. Xu M.D., G. X. Fu M.D. Ph.D. & Y. Zhong M.D.

  2. Clinical Laboratory, Shanghai Jiaotong University affiliated Shanghai Sixth People’s Hospital, Xuhui District, Shanghai, China

    Q. Q. Liu M.D.

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  1. C. C. Xu M.D.
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Correspondence to Y. Zhong M.D..

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Conflict of interest

C.C. Xu, G.X. Fu, Q.Q. Liu and Y. Zhong state that there are no conflicts of interest.

All participants provided written informed consent and the study was approved by the local ethics committee. All study procedures were carried out in accordance with the ethical standards outlined in the Declaration of Helsinki from 1975 as revised in 1983.

Additional information

An erratum to this article is available at https://doi.org/10.1007/s00391-016-1115-0.

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Xu, C.C., Fu, G.X., Liu, Q.Q. et al. Association between cystatin C and heart failure with preserved ejection fraction in elderly Chinese patients. Z Gerontol Geriat 51, 92–97 (2018). https://doi.org/10.1007/s00391-016-1058-5

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  • DOI: https://doi.org/10.1007/s00391-016-1058-5

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