title: Neutrophil gelatinase-associated lipocalin and cystatin C for the prediction of clinical events in patients with advanced heart failure and after ventricular assist device placement.
abstract: BACKGROUND
  Progressive renal dysfunction develops in patients with advanced HF. We evaluated neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C compared with established markers of renal function in patients with heart failure (HF) because they might improve prognostic assessment of patients with HF.
  
  
  METHODS
  Serum samples were collected from 40 patients with stable HF (age: 58 ± 8 years, body mass index [BMI]: 28.4 ± 6.4 kg/m(2)), 40 HF patients undergoing ventricular assist device (VAD) implantation (age: 53 ± 11 years, BMI: 26.8 ± 5.5 kg/m(2)), 40 patients undergoing VAD removal at cardiac transplantation, and 24 controls (age: 48 ± 7 years, BMI: 29.4 ± 4.2 kg/m(2)). Clinical data were collected from institutional medical records. NGAL and cystatin C levels were measured by enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease formula.
  
  
  RESULTS
  Patients with stable HF showed elevated NGAL and cystatin C levels compared with controls (NGAL: 114.9 ± 48.3 ng/mL vs 72.0 ± 36.6 ng/mL, p < 0.0001; cystatin C: 1490.4 ± 576.1 ng/mL vs 954.7 ± 414.2 ng/mL, p = 0.0026). Unlike cystatin C, NGAL increased in advanced HF patients requiring VAD implantation (158.7 ± 74.8 ng/mL, p < 0.001). On VAD support, NGAL levels decreased (127.1 ± 80.4 ng/mL, p = 0.034). NGAL was higher in patients who developed right ventricular failure (187.8 ± 66.0 vs 130.9 ± 67.0 ng/mL, p = 0.03) and irreversible renal dysfunction (190.0 ± 73.8 ng/mL vs 133.8 ± 54.2 ng/mL, p < 0.05), whereas cystatin C, creatinine, and eGFR were not different. NGAL correlated with eGFR (r = -0.2188, p = 0.01).
  
  
  CONCLUSIONS
  NGAL levels correlate with HF severity and hemodynamic improvement after VAD placement. Our findings suggest a role of this novel biomarker as a marker of severity and prognosis in patients with HF.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Pronschinske
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Cardiovascular Medicine and Organ Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Tuba
authors.initials: T
authors.lastname: Khawaja
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Templeton
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Maryjane A
authors.initials: MA
authors.lastname: Farr
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York. Electronic address: pcs2121@cumc.columbia.edu.
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000628:therapy
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: NGAL; cystatin C; heart failure; renal function; ventricular assist device