title: Use of myeloperoxidase for risk stratification in acute heart failure.
abstract: BACKGROUND
  Myeloperoxidase (MPO) is a biomarker of inflammation and oxidative stress produced by neutrophils, monocytes, and endothelial cells. Concentrations of MPO predict mortality in patients with chronic heart failure. This study sought to investigate the diagnostic accuracy and prognostic value of MPO in patients with acute heart failure (AHF).
  
  
  METHODS
  We prospectively enrolled 667 patients presenting to the emergency department with dyspnea and observed them for 1 year. MPO and B-type natriuretic peptide (BNP) were measured at presentation. Two independent cardiologists adjudicated final discharge diagnoses.
  
  
  RESULTS
  MPO concentrations were similar in patients with AHF (n = 377, median 139 pmol/L) and patients with noncardiac causes of dyspnea (n = 290, median 150 pmol/L, P = 0.26). The diagnostic accuracy of MPO for AHF was limited [area under the ROC curve (AUC) 0.53] and inferior to that of BNP (AUC 0.95, P < 0.001). In patients with AHF, MPO concentrations above the lowest tertile (MPO >99 pmol/L) were associated with significantly increased 1-year mortality (hazard ratio 1.58, P = 0.02). The combination of MPO (< or = 99 vs >99 pmol/L) and BNP (median of < or = 847 vs >847 ng/L) improved the prediction of 1-year mortality (hazard ratio 2.80 for both variables increased vs both low, P < 0.001). After adjustment for cardiovascular risk factors in multivariable Cox proportional hazard analysis, increases in MPO contributed significantly toward the prediction of 1-year mortality (hazard ratio 1.51, P = 0.045).
  
  
  CONCLUSIONS
  MPO is an independent predictor of 1-year mortality in AHF, is additive to BNP, and could be helpful in identifying patients with a favorable prognosis despite increased BNP concentrations.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Thenral
authors.initials: T
authors.lastname: Socrates
authors.forename: Patrick
authors.initials: P
authors.lastname: Egli
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Nisha
authors.initials: N
authors.lastname: Arenja
authors.forename: Julia
authors.initials: J
authors.lastname: Meissner
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Mirjam
authors.initials: M
authors.lastname: Reiter
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Nora
authors.initials: N
authors.lastname: Schaub
authors.forename: Andreas
authors.initials: A
authors.lastname: Buser
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000150:complications / Q000201:enzymology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000201:enzymology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009195:Peroxidase; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D009195:Peroxidase