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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

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