Journal Article Cholesterol metabolism as a prognostic marker in patients with mildly symptomatic nonischemic dilated cardiomyopathy

Akinori, Sawamura  ,  Takahiro, Okumura  ,  Hiroaki, Hiraiwa  ,  Soichiro, Aoki  ,  Toru, Kondo  ,  Takeo, Ichii  ,  Kenji, Furusawa  ,  Naoki, Watanabe  ,  Naoaki, Kano  ,  Kenji, Fukaya  ,  Ryota, Morimoto  ,  Yasuko, K. Bando  ,  Toyoaki, Murohara

69 ( 6 )  , pp.888 - 894 , 2017-06 , Elsevier
Background: Little is known about whether the alteration of cholesterol metabolism reflects abdominalorgan impairments due to heart failure. Therefore, we investigated the prognostic value of cholesterolmetabolism by evaluating serum campesterol and lathosterol levels in patients with early-stagenonischemic dilated cardiomyopathy (NIDCM).Methods: We enrolled 64 patients with NIDCM (median age 57.5 years, 31% female) with New YorkHeart Association functional class I/II. Serum campesterol and lathosterol levels were measured in allpatients. The patients were then divided into four subsets based on the median non-cholesterol sterollevels (campesterol 3.6 mg/mL, lathosterol 1.4 mg/mL): reference (R-subset), high-campesterol/high-lathosterol; absorption-reduced (A-subset), low-campesterol/high-lathosterol; synthesis-reduced (Ssubset),high-campesterol/low-lathosterol; double-reduced (D-subset), low-campesterol/low-lathos-terol. Endpoint was a composite of cardiac events, including cardiac-related death, hospitalization forworsening heart failure, and lethal arrhythmia.Results: Median brain natriuretic peptide (BNP) level was 114 pg/mL. Mean left ventricular ejectionfraction was 31.4%. D-subset had the lowest total cholesterol level and cardiac index and the highest BNPlevel and pulmonary capillary wedge pressure. D-subset also had the highest cardiac event rate duringthe mean 3.8 years of follow-up (log-rank p = 0.001). Multivariate regression analysis showed that Dsubsetwas an independent determinant of cardiac events. The receiver operating characteristic curveanalysis revealed that total cholesterol <153 mg/dL was a best cut-off value for discrimination of the Dsubset.Conclusions: The combined reduction of campesterol and lathosterol that indicated intestinalcholesterol absorption and liver synthesis predicts future cardiac events in patients with mildlysymptomatic NIDCM.

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