Dipeptidyl peptidase-IV in chronic heart failure with reduced ejection fraction.
BACKGROUND
An association between dipeptidyl peptidase-IV (DPP-IV) inhibitors with worse prognosis in HF has been suggested. We aimed to assess the serum DPP-IV levels in chronic stable HF patients and determine their association with prognosis.


RESULTS
Chronic stable HF patients with optimized prognostic-modifying therapy were prospectively recruited.


METHODS
1) ejection fraction>50%, 2) hospitalizations or therapeutic adjustments in the previous 2months; 3) patients on renal replacement therapy, and 4) use of DPP-IV inhibitors. A fasting venous blood sample was collected and DPP-IV was measured. Patients were followed-up for 3years and the endpoint studied was all-cause death. Patients' characteristics were compared according to DPP-IV quartiles. A Cox regression analysis was performed and multivariate models were built. The 3rd DPP-IV quartile was the reference category. We studied 264 patients. Mean age: 69 (±13)years, 70.5% were male and 33.7% diabetic. Median (IQR) serum DPP-IV levels were 455.6 (350.0-625.5)ng/mL. DPP-IV had an inverse relationship with age. Patients in 3rd DPP-IV quartile were in lower NYHA classes and had the lowest 3years all-cause mortality. Patients in the 1st DPP-IV quartile had a multivariate adjusted HR of 3-year mortality of 2.62 (95%CI: 1.15-5.95) when compared with reference category and the HR for the 4th quartile was of 3.79 (95%CI: 1.68-8.54).


CONCLUSIONS
There is a U-shaped association of serum DPP-IV with mortality in chronic systolic HF patients. Patients in the 3rd DPP-IV quartile have the best multivariate adjusted 3-year survival. DPP-IV inhibition might be harmful in patients with low DPP-IV.
Serviço de Medicina Interna,Centro Hospitalar São João, Portugal. Electronic address: pamlourenco@yahoo.com.
Patrícia
P
Lourenço
Serviço de Medicina Interna,Centro Hospitalar São João, Portugal.
Sérgio
S
Silva
Serviço de Endocrinologia, Centro Hospitalar São João, Portugal.
Filipe
F
Cunha
Serviço de Medicina Interna,Centro Hospitalar São João, Portugal.
Joana
J
Pereira
Serviço de Medicina Interna,Centro Hospitalar São João, Portugal.
Ana
A
Ribeiro
Serviço de Patologia Clínica, Centro Hospitalar São João, Portugal.
Nuno
N
Silva
Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Portugal; Serviço de Patologia Clínica, Centro Hospitalar São João, Portugal.
João Tiago
JT
Guimarães
Serviço de Medicina Interna,Centro Hospitalar São João, Portugal; Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Portugal.
José Paulo
JP
Araújo
Serviço de Medicina Interna,Centro Hospitalar São João, Portugal; Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Portugal.
Paulo
P
Bettencourt
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018819:Dipeptidyl Peptidase 4 / Q000097:blood*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*
D015415:Biomarkers; C042807:DPP4 protein, human; D018819:Dipeptidyl Peptidase 4
Chronic heart failure; Dipeptidyl peptidase-IV; Prognosis