This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.02.053v1 49/24/2364    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Tang, W.H. W. Articles by Klein, A. L. Search for Related Content PubMed Articles by Tang, W.H. W. Articles by Klein, A. L.

CLINICAL RESEARCH: BIOMARKER

Prognostic Value and Echocardiographic Determinants of Plasma Myeloperoxidase Levels in Chronic Heart Failure

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^_*

^_* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Christchurch School of Medicine, Christchurch, New Zealand.

Manuscript received October 17, 2006; revised manuscript received February 7, 2007, accepted February 8, 2007.

^_* 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. (Email: tangw{at}ccf.org).

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.

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   HF = heart failure   IQR = interquartile range   LV = left ventricular   LVEF = left ventricular ejection fraction   MPO = myeloperoxidase

This article has been cited by other articles:

				K. B. Shah, W. J. Kop, R. H. Christenson, D. B. Diercks, D. Kuo, S. Henderson, K. Hanson, M. R. Mehra, and C. R. deFilippi Lack of Diagnostic and Prognostic Utility of Circulating Plasma Myeloperoxidase Concentrations in Patients Presenting with Dyspnea Clin. Chem., January 1, 2009; 55(1): 59 - 67. [Abstract] [Full Text] [PDF]

				A. H.B. Wu Novel Biomarkers of Cardiovascular Disease: Myeloperoxidase for Acute and/or Chronic Heart Failure? Clin. Chem., January 1, 2009; 55(1): 12 - 14. [Full Text] [PDF]

				T. K. Rudolph, V. Rudolph, and S. Baldus Contribution of Myeloperoxidase to Smoking-dependent Vascular Inflammation Proceedings of the ATS, December 1, 2008; 5(8): 820 - 823. [Abstract] [Full Text] [PDF]

				W.H. W. Tang The ongoing search for a stratified medicine approach in heart failure. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2310 - 2312. [Full Text] [PDF]

				J. Shih, S. A. Datwyler, S. C. Hsu, M. S. Matias, D. P. Pacenti, C. Lueders, C. Mueller, O. Danne, and M. Mockel Effect of Collection Tube Type and Preanalytical Handling on Myeloperoxidase Concentrations Clin. Chem., June 1, 2008; 54(6): 1076 - 1079. [Abstract] [Full Text] [PDF]

				H. L. Gornik Peripheral arterial disease enters the biomarker era. Does risk stratification tell us something that we don't already know? Eur. Heart J., January 2, 2008; 29(2): 150 - 152. [Full Text] [PDF]

				W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., December 11, 2007; 50(24): 2344 - 2351. [Full Text] [PDF]