Valor pronóstico de la cistacina C como biomarcador en insuficiencia cardiaca crónica agudizada con función sistólica preservada y su relación con otros factores pronósticos clínicos

  1. Carrasco Sánchez, Francisco Javier
Supervised by:
  1. Carlos Ruiz Frutos Director
  2. Emilio Pujol de la Llave Director

Defence university: Universidad de Huelva

Fecha de defensa: 19 May 2009

  1. Manuel Montero Pérez-Barquero Chair
  2. Mariano Aguayo Canela Secretary
  3. Francisco J. Martínez Marcos Committee member
  4. Juan Ignacio Pérez Calvo Committee member
  5. Oscar Aramburu Bodas Committee member

Type: Thesis


The aim of the work is to identify if serum levels of cystatin C on admission in patients with heart failure with preserved systolic function (HFPSF) who were hospitalized for worsening symptoms reveal a poor prognosis. We measured cystatin C in a prospective study of patients (n=233) with LVEF>45%. During a follow-up period of 6 months, 90 patients (42.1%) reached primary endpoint (mortality or readmission). The best cut-off level was 1.35 mg/L obtained by a ROC curve. Cystatin C>1.35 mg/L was associated with adjusted HR 3.12 (95% CI 1.84-5.29, P<0.001). Other statistically significant predictor factors in Cox multivariable regression analysis were pulmonary hypertension (HR 2.56; 95% CI 1.67-3.91, P<0.001) and atrial fibrillation (HR 1.56; 95% CI 1.00-2.44, P=0.037). All-cause mortality at 180 days was 23.4%. Kaplan-Meier survival curves showed higher mortality in patients with cystatin C above cut-off (log rank<0.0001). In conclusion, cystatin C is a strong and independent predictor of an unfavourable outcome.