title: Prognostic value of pigment epithelium-derived factor in patients with advanced heart failure.
abstract: OBJECTIVE
  Whereas angiogenesis, the formation of new blood vessels from preexisting vessels, may be beneficial in restoring failing myocardium, apoptosis may contribute to the progression of heart failure (HF). We investigated the role of pigment epithelium-derived factor (PEDF), a recently discovered antiangiogenic factor with additional proapoptotic effects, in patients with advanced HF.
  
  
  METHODS
  We assayed PEDF levels in 351 patients with advanced HF at baseline. During the median follow-up time of 16 months, 50% of patients experienced the composite end point of rehospitalization and/or death.
  
  
  RESULTS
  The risk of a clinical event increased with concentrations of the antiangiogenic marker PEDF, with a 1.94-fold higher risk in the third tertile compared with the first tertile (95% CI, 1.33-2.84). This association remained significant after adjustment for B-type natriuretic peptide (BNP) and other risk factors in a Cox regression model (P = .015). Experimental data revealed that PEDF may contribute to the progression of HF by inducing apoptosis in human cardiac myocytes and fibroblasts via activation of caspase 3.
  
  
  CONCLUSIONS
  We suggest a role of PEDF in the progression of HF by inducing apoptosis of human cardiac myocytes and fibroblasts. Our clinical data suggest that PEDF concentrations may have the potential to become a valuable marker of the prognosis of HF, in addition to BNP.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Rychli
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
authors.forename: Philipp J
authors.initials: PJ
authors.lastname: Hohensinner
authors.forename: Kariem
authors.initials: K
authors.lastname: Mahdy Ali
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaun
authors.forename: Stephanie
authors.initials: S
authors.lastname: Neuhold
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Zorn
authors.forename: Bernhard
authors.initials: B
authors.lastname: Richter
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
authors.forename: Deddo
authors.initials: D
authors.lastname: Mörtl
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018572:Disease-Free Survival; D005136:Eye Proteins / Q000097:blood*; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015843:Serpins / Q000097:blood*; D015996:Survival Rate; D000099174:Pigment Epithelium-Derived Factor
chemical_list: D015415:Biomarkers; D005136:Eye Proteins; D009414:Nerve Growth Factors; D015843:Serpins; D000099174:Pigment Epithelium-Derived Factor