The value of serum homocysteine level in predicting one-year survival in patients with severe systolic heart failure

OBJECTIVES
Heart failure (HF) is a major public health problem responsible for high morbidity and mortality rates. Thus, the importance of survival predictors in directing the treatment of HF is gradually increasing. In some recently published studies, plasma homocysteine has been reported as a newly recognized risk factor for the development of HF. In the present study, we investigated the value of serum homocysteine levels in predicting the survival of patients with HF.

STUDY DESIGN
Seventy HF patients (44 males, 26 females; mean age 60±12; range 28 to 83 years) with left ventricle ejection fractions of <35% were included in our study. Clinical, echocardiographic, and biochemical parameters were measured at baseline, and all patients were followed. Cardiac death was established as the end point of the study.

RESULTS
At the end of the 12 month follow-up period, 14 patients (20%) had died. Serum homocysteine levels were significantly higher in the deceased patients compared to the patients who survived (20.8±5.8 vs. 16.9±5.1 µmol/l, p=0.029). A serum homocysteine level of >17.45 µmol/l predicted death at the end of the first year with 71.4% specificity and 67.9% sensitivity (ROC area under curve: 0.855, CI 95% 0.792-0.965, p<0.001). Multivariate Cox regression analysis showed that the serum homocysteine level was the only parameter predicting survival.

CONCLUSION
Serum homocysteine level may be an important predictor of mid-term mortality in patients with HF.