Prognostic role of metabolic risk factors (hyperhomocysteinemia) in the development of chronic heart failure

The aim of the study was to assess the relationship of homocysteine levels in the blood serum with the severity and nature of chronic heart failure (CHF) in patients with coronary heart disease. 94 patients with CHF were examined. The control group included 32 patients without cardiovascular disorders. At baseline and after 12 months of observation the homocysteine levels in the blood serum were determined by enzyme-linked immunosorbent assay. Correlative relationship of hyperhomocysteinemia with ischemic myocardial remodeling and with reduced inotropic function in CHF patients was observed. The homocysteine level in the blood serum of CHF patients significantly exceeded that of the control group and moderately increased with the progression of the disease severity of functional class. In the group with an unfavorable course of CHF the baseline homocysteine level proved to have the greatest value as compared to that in the group with a favorable course. In patients with a favorable course of CHF the homocysteinemia level tended to decrease towards the end of prospective study, whereas in patients with an unfavorable course, on the contrary, hyperhomocysteinemia persisted (p<0.01). In case the hyperhomocysteinemia baseline exceeds 18.5 mkmol/L (ROC-AreaSE = 0.860.04, sensitivity 71 %, specificity 90%), the severity and characteristics of the ischemic CHF could be most likely predicted. Thus, hyperhomocysteinemia is related with the severity and nature of CHF. Determining the level of homocysteine in the blood serum can be recommended for early prediction of the severity and nature of CHF.