title: Prognostic value of homocysteinemia in patients with congestive heart failure.
abstract: BACKGROUND
  Elevated plasma homocysteine levels are associated with increased risk of vascular disease and of congestive heart failure (CHF), with a relationship between homocysteine values and disease severity. Hyperhomocysteinemia is a risk factor for cardiac dysfunction. In this study, the predictive value of elevated homocysteine levels was investigated in the prognosis of ischemic and non-ischemic CHF.
  
  
  METHODS
  A total of 159 patients with CHF, 89 with non-ischemic and 70 with ischemic CHF (83% males, mean age 62 years, mean ejection fraction 27%), and 119 controls (79% males, mean age 59.8 years) had fasting blood samples taken to measure plasma homocysteine, vitamin B(12) and folate levels. Coronary angiography was performed for all patients. The mean duration of follow-up was 49.6+/-36.7 months.
  
  
  RESULTS
  As in other studies, the mean level of homocysteinemia was significantly higher in the CHF group (15.80 micromol/L) than in the control group (10.90 micromol/L) (p=0.001) whatever the etiology (non-ischemic, 16.11+/-6.84 micromol/L; ischemic, 15.41+/-6.45 micromol/L). This result was observed without vitamin deficiency, but in patients, the mean creatinine value was moderately higher than in controls. We found a positive correlation between plasma homocysteine levels and New York Heart Association (NYHA) classification, creatinine and age. Moreover, hyperhomocysteinemia appears to be a powerful predictive factor of mortality in CHF patients (relative risk of death, 4.23; p=0.0003). In the follow-up of this study, 41.5% of patients with homocysteinemia >17 micromol/L died vs. 21.3% of patients with levels <17 micromol/L. In multivariate analysis, when homocysteine levels were adjusted for a second parameter (age, NYHA, creatinine, diabetes), the risk of death remained significant after each adjustment.
  
  
  CONCLUSIONS
  Elevated homocysteine levels observed in CHF patients, whatever the etiology of their heart disease (ischemic or non-ischemic), were correlated with the severity of the disease. Hyperhomocysteinemia appears to be a predictive factor of mortality in CHF patients.
authors.affiliation: Cardiology Department, Hôpital Pasteur, Nice, France. gibelinp@cote-dazur.com
authors.forename: Pierre
authors.initials: P
authors.lastname: Gibelin
authors.forename: Stephanie
authors.initials: S
authors.lastname: Serre
authors.forename: Mirande
authors.initials: M
authors.lastname: Candito
authors.forename: Bakhouche
authors.initials: B
authors.lastname: Houcher
authors.forename: Frederic
authors.initials: F
authors.lastname: Berthier
authors.forename: Marcel
authors.initials: M
authors.lastname: Baudouy
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000145:classification / Q000473:pathology*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate
chemical_list: D006710:Homocysteine