title: Incremental prognostic significance of the elevated levels of pentraxin 3 in patients with heart failure with normal left ventricular ejection fraction.
abstract: BACKGROUND
  Pentraxin 3 (PTX3) is a novel inflammatory marker produced by various cell types including those of the vasculature and the heart. The relationship between inflammatory markers and prognosis of patients with heart failure with normal ejection fraction (HFNEF) remains unknown. We investigated whether plasma PTX3 levels can predict future cardiovascular events in patients with HFNEF.
  
  
  RESULTS
  Plasma PTX3, high-sensitivity C-reactive protein, and B-type natriuretic peptide levels were measured prospectively in 360 stable patients with HFNEF. The subsequent incidence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction (MI), unstable angina pectoris, nonfatal ischemic stroke, hospitalization for heart failure decompensation, and coronary revascularization, was determined. During a mean 30-month follow-up, 106 patients experienced cardiovascular events. These events were more frequent in patients with high plasma PTX3 levels (>3.0 ng/mL) than low levels (≤3.0 ng/mL). Multivariable Cox hazard analysis showed that PTX3 (hazard ratio: 1.16; 95% CI: 1.05 to 1.27; P<0.01) and B-type natriuretic peptide (hazard ratio: 1.08; 95% CI: 1.03 to 1.14; P<0.001), but not high-sensitivity C-reactive protein levels, were significant predictors of future cardiovascular events. Multivariable Cox analysis with the forced inclusion model, including 5 previously identified prognostic factors, found that PTX3 was a significant predictor of cardiovascular events (hazard ratio: 1.16; 95% CI: 1.06 to 1.27; P<0.01). The C-statistics for cardiovascular events substantially increased from 0.617 to 0.683 when PTX3 was added to the 5 previously identified prognostic factors.
  
  
  CONCLUSIONS
  High plasma PTX3 levels, but not other inflammatory markers, are correlated with future cardiovascular events in patients with HFNEF. PTX3 may be a useful biomarker for assessment of risk stratification in HFNEF.
  
  
  BACKGROUND
  http://www.umin.ac.jp; Unique identifier: UMIN000002170.
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.) Department of Cardiovascular Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan (J.M.).
authors.forename: Junichi
authors.initials: J
authors.lastname: Matsubara
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.) Department of Cardiovascular Medicine, and Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan (S.S., H.J.).
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Nozaki
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Eiichi
authors.initials: E
authors.lastname: Akiyama
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan (Y.M.).
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzawa
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kurokawa
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Koichiro
authors.initials: K
authors.lastname: Fujisue
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Koichi
authors.initials: K
authors.lastname: Sugamura
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yamamoto
authors.affiliation: Department of Community Medicine, Kumamoto University Hospital, Kumamoto, Japan (K.M.).
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Cardiovascular Medicine, and Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan (S.S., H.J.) Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan (H.J.).
authors.forename: Hideaki
authors.initials: H
authors.lastname: Jinnouchi
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.).
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000378:metabolism; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011379:Prognosis; D000683:Serum Amyloid P-Component / Q000378:metabolism*; D020521:Stroke / Q000453:epidemiology / Q000378:metabolism; D013318:Stroke Volume; D000099153:Pentraxins
chemical_list: D002097:C-Reactive Protein; D020097:Natriuretic Peptide, Brain; D000683:Serum Amyloid P-Component; D000099153:Pentraxins
keywords: cardiovascular events; heart failure with normal ejection fraction; inflammation; left ventricular diastolic dysfunction; pentraxin 3