TY - JOUR T1 - Cystatin C concentration as a predictor of systolic and diastolic heart failure. JF - J Card Fail Y1 - 2008 A1 - Moran, Andrew A1 - Katz, Ronit A1 - Smith, Nicolas L A1 - Fried, Linda F A1 - Sarnak, Mark J A1 - Seliger, Stephen L A1 - Psaty, Bruce A1 - Siscovick, David S A1 - Gottdiener, John S A1 - Shlipak, Michael G KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - Cohort Studies KW - Confidence Intervals KW - Cystatin C KW - Cystatins KW - Echocardiography KW - Female KW - Heart Failure, Diastolic KW - Heart Failure, Systolic KW - Humans KW - Longitudinal Studies KW - Male KW - Predictive Value of Tests KW - Probability KW - Proportional Hazards Models KW - Risk Assessment KW - Sensitivity and Specificity KW - Stroke Volume KW - Survival Analysis AB -

BACKGROUND: Risk factors for heart failure (HF) may differ according to ejection fraction (EF). Higher cystatin C, a marker of kidney dysfunction, is associated with incident HF, but previous studies did not determine EF at diagnosis. We hypothesized that kidney dysfunction would predict diastolic HF (DHF) better than systolic HF (SHF) in the Cardiovascular Health Study.

METHODS AND RESULTS: Cystatin C was measured in 4453 participants without HF at baseline. Incident HF was categorized as DHF (EF > or = 50%) or SHF (EF < 50%). We compared the association of cystatin C with the risk for DHF and SHF, after adjustment for age, sex, race, medications, and HF risk factors. During 8 years of follow-up, 167 participants developed DHF and 206 participants developed SHF. After adjustment, sequentially higher quartiles of cystatin C were associated with risk for SHF (competing risks hazard ratios 1.0 [reference], 1.99 [95% confidence interval 1.14-3.48], 2.32 [1.32-4.07], 3.17 [1.82-5.50], P for trend < .001). The risk for DHF was apparent only at the highest cystatin C quartile (hazard ratios 1.0 [reference], 1.09 [0.62-1.89], 1.08 [0.61-1.93], and 1.83 [1.07-3.11]).

CONCLUSIONS: Cystatin C levels are linearly associated with the incidence of systolic HF, whereas only the highest concentrations of cystatin C predict diastolic HF.

VL - 14 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18226769?dopt=Abstract ER -