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Relation of circulating cardiac myosin light chain 1 isoform in stable severe congestive heart failure to survival and treatment with flosequinan.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2002 Nov 01; Vol. 90 (9), pp. 969-73. - Publication Year :
- 2002
-
Abstract
- The myocardial contractile protein myosin light chain 1 isoform (MLC-1) is released into the circulation during myocyte necrosis and could thus be a marker of low-grade myocardial damage and of poor prognosis in patients with heart failure. Two hundred eighteen patients with stable heart failure (ejection fraction [EF] <35%) and in New York Heart Association (NYHA) class III to IV had MLC-1 measured at baseline and 1 month after being randomized to the direct vasodilator flosequinan or placebo. Patients were followed a mean of 302 +/- 142 days. The prognostic value of an increase in MLC-1 above the 98th percentile of normal controls was compared with that of conventional prognostic variables in heart failure. MLC-1 was increased in over half of patients at baseline and 1 month, and this was associated with increased age, NYHA class IV, and renal insufficiency. By Kaplan-Meier survival analysis, patients with a baseline increase in MLC-1 had a greater mortality (26%) than those without an increase (15%) (p = 0.043). A significant interaction among MLC-1, survival, and treatment was found (p = 0.043). In the placebo group, MLC-1 was associated with increased mortality (29% vs 12%, p = 0.025), whereas there was no significant difference among patients receiving flosequinan. In a multivariate logistic regression model including age, treatment, and left ventricular (LV) ejection fraction, the MLC-1 chain was most predictive of mortality (p = 0.049). Thus, circulating MLC-1 is elevated in over half of patients with stable severe heart failure, and this increase is associated with a poor prognosis. Flosequinan treatment eliminates this association, highlighting the complexity of the relation between cardiac myocyte damage, drug treatment, and mortality.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers blood
Double-Blind Method
Female
Follow-Up Studies
Heart Failure mortality
Humans
Male
Middle Aged
Multivariate Analysis
North America
Predictive Value of Tests
Prospective Studies
Scandinavian and Nordic Countries
Severity of Illness Index
Stroke Volume drug effects
Stroke Volume physiology
Survival Analysis
Treatment Outcome
Heart Failure blood
Heart Failure drug therapy
Myosin Light Chains blood
Myosin Light Chains drug effects
Quinolines therapeutic use
Vasodilator Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0002-9149
- Volume :
- 90
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 12398964
- Full Text :
- https://doi.org/10.1016/s0002-9149(02)02663-2