Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2017; 9(5): 457-465
Published online May 26, 2017. doi: 10.4330/wjc.v9.i5.457
Combined assessment of myocardial damage and electrical disturbance in chronic heart failure
Shinpei Kadowaki, Tetsu Watanabe, Yoichiro Otaki, Taro Narumi, Yuki Honda, Hiroki Takahashi, Takanori Arimoto, Tetsuro Shishido, Takuya Miyamoto, Isao Kubota
Shinpei Kadowaki, Tetsu Watanabe, Yoichiro Otaki, Taro Narumi, Yuki Honda, Hiroki Takahashi, Takanori Arimoto, Tetsuro Shishido, Takuya Miyamoto, Isao Kubota, Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan
Author contributions: In this study, Kadowaki S helped design the study, obtained and analyzed data, and drafted the manuscript; Watanabe T and Kubota I contributed to discussions about study design and data analyses; Kadowaki S, Otaki Y, Narumi T, Honda Y, Takahashi H, Arimoto T, Shishido T and Miyamoto T were involved with data collection, and assisted with data analysis; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Ethics Committee of Yamagata University School of Medicine, Yamagata in Japan.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tetsu Watanabe, MD, PhD, Assistant Professor, Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan. tewatana@med.id.yamagata-u.ac.jp
Telephone: +81-23-6285302 Fax: +81-23-6285305
Received: October 17, 2016
Peer-review started: October 23, 2016
First decision: December 1, 2016
Revised: March 13, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: May 26, 2017
Processing time: 214 Days and 19.2 Hours
Abstract
AIM

To investigate feasibility of combined assessment of biochemical and electrophysiological myocardial impairment markers risk-stratifying patients with chronic heart failure (CHF).

METHODS

Serum levels of heart-type fatty acid binding protein (H-FABP) as a marker of ongoing myocardial damage and QRS duration on electrocardiogram were measured at admission in 322 consecutive patients with CHF. A prolonged QRS duration was defined as 120 ms or longer. The cut-off value for H-FABP level (4.5 ng/mL) was determined from a previous study. Patients were prospectively followed during a median follow up period of 534 d. The primary endpoint was cardiac deaths and rehospitalization for worsening CHF.

RESULTS

There were 117 primary events, including 27 cardiac deaths and 90 rehospitalizations. Patients were stratified into four groups according to H-FABP level and QRS duration (≥ 120 ms). Multivariate analysis demonstrated that high H-FABP levels [hazard ratio (HR) = 1.745, P = 0.021] and QRS prolongation (HR 1.612, P = 0.0258) were independent predictors of cardiac events. Kaplan-Meier analysis demonstrated that the combination of high H-FABP levels and QRS prolongation could be used to reliably stratify patients at high risk for cardiac events (log rank test P < 0.0001).

CONCLUSION

Combined assessment of myocardial damage and electrical disturbance can be used to risk-stratify patients with CHF.

Keywords: QRS prolongation; Heart-type fatty acid binding protein; Heart failure; Prognosis

Core tip: This was a prospective single center study with 322 consecutive patients with chronic heart failure (CHF) seeking to evaluate the feasibility of combined assessment of biochemical and electrophysiological markers of myocardial impairment for risk-stratifying patients with CHF. QRS prolongation and high heart-type fatty acid binding protein levels are independently associated with cardiac events in patients with CHF.