title: Plasma B vitamins and their relation to the severity of chronic heart failure.
abstract: BACKGROUND
  Total homocysteine (tHcy) has been linked to the severity of chronic heart failure (CHF). Elevated tHcy concentrations are mainly caused by folate and vitamin B-12 deficiencies.
  
  
  OBJECTIVE
  We hypothesized that folate and vitamin B-12 deficiencies can explain the relation between tHcy and the severity of CHF.
  
  
  METHODS
  We investigated 987 CHF patients. All subjects underwent a physical examination and blood sampling. Cardiac catheterization was performed in 929 patients and echocardiography in 460 patients. Serum tHcy, folate, vitamin B-12, and N-terminal pro-B-type natriuretic-peptide (NT-proBNP) were measured and renal and hepatic function were studied.
  
  
  RESULTS
  tHcy increased with increasing New York Heart Association (NYHA) classes of heart failure (P < 0.001) and correlated with the left ventricular ejection fraction (EF; r = -0.150, P < 0.001). Contrary to the hypothesis, vitamin B-12 (P < 0.001) increased with NYHA class (P < 0.001) and was negatively correlated with EF (r = -0.080, P = 0.015). Folate showed no relation with NYHA class or EF. Comparable results were obtained for NT-proBNP (tHcy: r = 0.27, P < 0.001; vitamin B-12: r = 0.091, P = 0.004; folate: r = -0.045, P = 0.169). The correlations between tHcy, EF, and NT-proBNP were significantly stronger in patients without coronary artery disease (CAD) than in those with CAD. Regression analysis showed that tHcy, but not B vitamins, is a strong predictor of EF and NT-proBNP.
  
  
  CONCLUSIONS
  This study showed that tHcy, but not folate and vitamin B-12, is related to clinical, echocardiographic, and laboratory variables of CHF, which indicates a relation between tHcy and the severity of CHF. This relation is stronger in patients without CAD. The lack of association of folate and the paradoxical relation of vitamin B-12 with CHF can possibly be explained by a disturbance in hepatic homeostasis.
authors.affiliation: Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Saarland, Homburg/Saar, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Herrmann
authors.forename: Stephanie
authors.initials: S
authors.lastname: Müller
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kindermann
authors.forename: Laureen
authors.initials: L
authors.lastname: Günther
authors.forename: Jochem
authors.initials: J
authors.lastname: König
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herrmann
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D005492:Folic Acid / Q000097:blood; D005494:Folic Acid Deficiency / Q000097:blood* / Q000150:complications; D006333:Heart Failure / Q000097:blood* / Q000209:etiology / Q000473:pathology; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000097:blood* / Q000150:complications; D014803:Vitamin B Complex / Q000097:blood*
chemical_list: D006710:Homocysteine; D014803:Vitamin B Complex; D005492:Folic Acid; D014805:Vitamin B 12