Usefulness of Elevated Urine Neopterin Levels In Assessing Cardiac Dysfunction AND Exercise Ventilation Inefficiency in Patients with Chronic Systolic Heart Failure

摘要

Neopterin is synthesized by macrophages upon stimulation with γ-interferon, and high neopterin production is associated with cellular immune activation and increased production of reactive oxygen species (oxidant stress), but the clinical utility of urine neopterin levels in patients with heart failure (HF) have not been explored. 53 ambulatory patients with chronic systolic HF (left ventricular [LV] ejection fraction ≤40%) underwent comprehensive echocardiographic evaluation and cardiopulmonary exercise testing. Urine neopterin levels were quantified by liquid chromatography with tandem mass spectrometric analyses and corrected to urine creatinine (Cr) levels. In our study cohort, median urine neopterin level was 60 [interquartile range 40–86] μmol/mol Cr. There were modest correlations between urine neopterin levels and abnormalities in cardiac structure and function by echocardiography: LV ejection fraction (r= −0.33, p=0.017), indexed LV end-diastolic volume (r=0.31, p=0.029), indexed LV end-systolic volume (r=0.32, p=0.024), and E/septal Ea (r=0.28, p=0.041). Although there was no significant correlation between urine neopterin and maximal oxygen uptake (peak VO2: r= −0.25, p=0.07), there was a modest correlation between urine neopterin and maximal ventilation/carbon dioxide production ratio (VE/VCO2 max: r=0.38, p=0.005). In conclusion, increase in urine neopterin levels track with disease severity in patients with chronic systolic heart failure.