title: Elevated serum cobalamin in patients with decompensated biventricular failure.
abstract: BACKGROUND
  Serum cobalamin (vitamin B12), bound to transcobalamin II, is taken up by the endothelium of the hepatic vasculature via a receptor-mediated membrane transport process. We hypothesized hepatic congestion is associated with elevated serum B12 without hepatocyte necrosis.
  
  
  RESULTS
  Serum B12, aspartate and alanine transaminases, alkaline phosphatase, bilirubin (Bili), and brain natriuretic peptide (BNP) were monitored at the time of admission in 91 hospitalized patients: (a) 38 with decompensated biventricular failure having systemic venous distention, tricuspid regurgitation (TR), and echocardiographic evidence of inferior vena cava dilation and moderate to marked TR; (b) 18 with acute left heart failure having a myocardial infarction, an ischemic cardiomyopathy, or hypertensive heart disease; and (c) 35 without clinical evidence of failure despite myocardial infarction, pericarditis, or atrial arrhythmia. Serum cobalamin (normal 180-600 pg/mL) was elevated with biventricular failure (861.4 +/- 53.0 pg/mL) compared with (P < 0.0001) left heart or no failure, where B12 remained normal. Serum aspartate, alanine, and alkaline phosphatase were normal in each group whereas Bili was increased (1.8 +/- 0.2 mg/dL; P < 0.05) with biventricular failure. Plasma BNP was elevated in each group.
  
  
  CONCLUSIONS
  Elevated cobalamin and Bili are respective biomarkers of hepatocellular dysfunction and cholestasis in patients having decompensated biventricular failure with systemic venous distention and TR without hepatocyte necrosis vis-à-vis left heart failure or in the absence of clinical failure. Elevated plasma BNP did not distinguish between the presence or absence of systemic venous congestion.
authors.affiliation: Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
authors.forename: Haris
authors.initials: H
authors.lastname: Zafarullah
authors.forename: Atta U
authors.initials: AU
authors.lastname: Shahbaz
authors.forename: Ragheed
authors.initials: R
authors.lastname: Alturkmani
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Laguardia
authors.forename: Basil M
authors.initials: BM
authors.lastname: Paulus
authors.forename: David L
authors.initials: DL
authors.lastname: Battin
authors.forename: M Omer
authors.initials: MO
authors.lastname: Afzal
authors.forename: Richard C
authors.initials: RC
authors.lastname: Davis
authors.forename: J Lacey
authors.initials: JL
authors.lastname: Smith
authors.forename: Karl T
authors.initials: KT
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D008099:Liver / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018754:Ventricular Dysfunction / Q000097:blood*; D014805:Vitamin B 12 / Q000097:blood*; D014803:Vitamin B Complex / Q000097:blood*; D055815:Young Adult
chemical_list: D020097:Natriuretic Peptide, Brain; D014803:Vitamin B Complex; D014805:Vitamin B 12