title: Neopterin levels are independently associated with cardiac remodeling in patients with chronic heart failure.
abstract: OBJECTIVE
  Neopterin, a marker of inflammation and monocyte activation, is found increased in patients with heart failure (HF). This study investigates whether neopterin levels correlate with left ventricular (LV) remodeling and brain natriuretic peptide (BNP), a marker of cardiac stress, in chronic HF (CHF) patients with different severity of disease.
  
  
  METHODS
  The relationship between neopterin and LV dimensions, NT-proBNP, and pro-inflammatory cytokines were studied in 98 CHF patients, while nineteen healthy subjects were enrolled as controls. Nineteen (19%) patients were in NYHA class I, 38 (39%) in NYHA class II, 27 (28%) in NYHA class III, and 14 (14%) in NYHA class IV.
  
  
  RESULTS
  Neopterin levels were higher in CHF patients than in age- and gender-matched healthy controls, and related with indexed LV end-diastolic volume (LVEDVi). Prospectively CHF patients were separated into tertiles of low, medium and high neopterin levels. Among patients, male gender, LVEDVi, diuretic treatment, NYHA class I, NT-proBNP and IL-8 levels were significant determinants of urine neopterin levels by bivariate analysis. Neopterin levels were associated only to LV remodeling, as assessed by LVEDVi, and IL-8 levels, a crucial monocyte chemoattractant, by multivariate ordinal regression analysis.
  
  
  CONCLUSIONS
  The relationship between elevated neopterin levels and LV enlargement in CHF patients suggests a crucial role of monocyte activation in the development of cardiac dysfunction in CHF patients. Assessment of neopterin levels is a potential biomarker to evaluate the progression of LV remodeling in CHF patients.
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy. raffaele.caruso@ospedaleniguarda.it
authors.forename: R
authors.initials: R
authors.lastname: Caruso
authors.forename: B
authors.initials: B
authors.lastname: De Chiara
authors.forename: J
authors.initials: J
authors.lastname: Campolo
authors.forename: A
authors.initials: A
authors.lastname: Verde
authors.forename: F
authors.initials: F
authors.lastname: Musca
authors.forename: O
authors.initials: O
authors.lastname: Belli
authors.forename: M
authors.initials: M
authors.lastname: Parolini
authors.forename: L
authors.initials: L
authors.lastname: Cozzi
authors.forename: A
authors.initials: A
authors.lastname: Moreo
authors.forename: M
authors.initials: M
authors.lastname: Frigerio
authors.forename: O
authors.initials: O
authors.lastname: Parodi
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology*; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000502:physiology; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D019798:Neopterin / Q000097:blood*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D015415:Biomarkers; D016209:Interleukin-8; D020097:Natriuretic Peptide, Brain; D019798:Neopterin