Fractalkine is an independent predictor of mortality in patients with advanced heart failure

Bernhard Richter; Lorenz Koller; Philipp J. Hohensinner; Kathrin Rychli; Gerlinde Zorn; Georg Goliasch; Rudolf Berger; Deddo Mörtl; Gerald Maurer; Kurt Huber; Richard Pacher; Johann Wojta; Martin Hülsmann; Alexander Niessner

doi:10.1160/TH12-03-0195

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2012; 108(06): 1220-1227
DOI: 10.1160/TH12-03-0195

Wound Healing and Inflammation/Infection

Schattauer GmbH

Fractalkine is an independent predictor of mortality in patients with advanced heart failure

Bernhard Richter

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Lorenz Koller

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Philipp J. Hohensinner

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Kathrin Rychli

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Gerlinde Zorn

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Georg Goliasch

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Rudolf Berger

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Deddo Mörtl

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Gerald Maurer

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Kurt Huber

²Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria

,

Richard Pacher

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Johann Wojta

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Martin Hülsmann

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

,

Alexander Niessner

¹Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria

› Institutsangaben

Abstract

Summary

Immunological processes are implicated in the multifactorial pathophysiology of heart failure (HF). The multifunctional chemokine fractalkine (CX3CL1) promotes the extravasation of cytotoxic lymphocytes into tissues. We aimed to assess the prognostic value of fractalkine in HF. Fractalkine plasma levels were determined in 349 patients with advanced systolic HF (median 75 years, 66% male). During a median follow-up of 4.9 years (interquartile range: 4.6–5.2), 55.9% of patients died. Fractalkine was a significant predictor of all-cause mortality (p <0.001) with a hazard ratio of 2.78 (95% confidence interval: 1.95–3.95) for the third compared to the first tertile. This association remained significant after multivariable adjustment for demographics, clinical predictive variables and N-terminal pro-B-type natriuretic peptide (NT-proBNP, p=0.008). The predictive value of fractalkine did not significantly differ between patients with ischaemic and non-ischaemic HF aetiology (p=0.79). The predictive value of fractalkine tertiles was not significantly modified by tertiles of NT-proBNP (p=0.18) but was more pronounced in the first and third tertile of NT-proBNP. Fractalkine was also an independent predictor of cardiovascular mortality (p=0.015). Fractalkine levels were significantly lower in patients on angiotensin-converting enzyme inhibitor therapy (p <0.001). In conclusion, circulating fractalkine with its pro-inflammatory and immunomodulatory effects is an independent predictor of mortality in advanced HF patients. Fractalkine improves risk prediction beyond NTproBNP and might therefore help to identify high risk patients who need special care. Our data indicate the implication of immune modulation in HF pathology.

Keywords

Fractalkine - chemokine - heart failure - immunology - prognosis

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Referenzen

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