Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure

Cheol Whan Lee, Jung Hee Lee, Tae Hwan Lim, Hyun Suk Yang, Myeongki Hong, Jae Kwan Song, Seong Wook Park, Seung Jung Park, Jae Joong Kim

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background - Cerebral metabolic abnormalities were proposed as a potential marker of disease severity in congestive heart failure (CHF), but their prognostic significance remains uncertain. Methods and Results - We investigated the prognostic value of cerebral metabolic abnormalities in 130 consecutive patients with advanced CHF (100 men aged 42.6±11.9 years; left ventricular ejection fraction, 22.2±6.2%). Proton magnetic resonance spectroscopy data were obtained from localized regions (≈8 mL) of the occipital gray matter and the parietal white matter. The primary end point was the occurrence of death after the proton magnetic resonance spectroscopy. During follow-up (18.5±14.4 months), 21 patients died and 15 underwent urgent heart transplantation. In the Cox proportional model, occipital metabolites (N-acetylaspartate, creatine, choline, and myoinositol), parietal N-acetylaspartate level, and the duration of CHF symptoms (> 12 months) were validated as univariate predictors of death. In multivariate Cox analyses, however, the occipital N-acetylaspartate level was an independent predictor of death (hazard ratio, 0.52; 95% CI, 0.41 to 0.67; P<0.001). An analysis with respect to the combined end point of death or urgent transplantation showed similar results. The best cutoff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75% sensitivity and 67% specificity to predict mortality. Conclusions - The occipital N-acetylaspartate level is a powerful and independent predictor of CHF mortality, suggesting that cerebral metabolic abnormalities may be used as a new prognostic marker in the assessment of patients with CHF.

Original languageEnglish
Pages (from-to)2784-2787
Number of pages4
JournalCirculation
Volume103
Issue number23
DOIs
Publication statusPublished - 2001 Jun 12

Fingerprint

Heart Failure
Mortality
Creatine
Inositol
Heart Transplantation
Choline
Proportional Hazards Models
Stroke Volume
Multivariate Analysis
Transplantation
N-acetylaspartate
Sensitivity and Specificity
Proton Magnetic Resonance Spectroscopy

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lee, Cheol Whan ; Lee, Jung Hee ; Lim, Tae Hwan ; Yang, Hyun Suk ; Hong, Myeongki ; Song, Jae Kwan ; Park, Seong Wook ; Park, Seung Jung ; Kim, Jae Joong. / Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure. In: Circulation. 2001 ; Vol. 103, No. 23. pp. 2784-2787.
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abstract = "Background - Cerebral metabolic abnormalities were proposed as a potential marker of disease severity in congestive heart failure (CHF), but their prognostic significance remains uncertain. Methods and Results - We investigated the prognostic value of cerebral metabolic abnormalities in 130 consecutive patients with advanced CHF (100 men aged 42.6±11.9 years; left ventricular ejection fraction, 22.2±6.2{\%}). Proton magnetic resonance spectroscopy data were obtained from localized regions (≈8 mL) of the occipital gray matter and the parietal white matter. The primary end point was the occurrence of death after the proton magnetic resonance spectroscopy. During follow-up (18.5±14.4 months), 21 patients died and 15 underwent urgent heart transplantation. In the Cox proportional model, occipital metabolites (N-acetylaspartate, creatine, choline, and myoinositol), parietal N-acetylaspartate level, and the duration of CHF symptoms (> 12 months) were validated as univariate predictors of death. In multivariate Cox analyses, however, the occipital N-acetylaspartate level was an independent predictor of death (hazard ratio, 0.52; 95{\%} CI, 0.41 to 0.67; P<0.001). An analysis with respect to the combined end point of death or urgent transplantation showed similar results. The best cutoff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75{\%} sensitivity and 67{\%} specificity to predict mortality. Conclusions - The occipital N-acetylaspartate level is a powerful and independent predictor of CHF mortality, suggesting that cerebral metabolic abnormalities may be used as a new prognostic marker in the assessment of patients with CHF.",
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Lee, CW, Lee, JH, Lim, TH, Yang, HS, Hong, M, Song, JK, Park, SW, Park, SJ & Kim, JJ 2001, 'Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure', Circulation, vol. 103, no. 23, pp. 2784-2787. https://doi.org/10.1161/01.CIR.103.23.2784

Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure. / Lee, Cheol Whan; Lee, Jung Hee; Lim, Tae Hwan; Yang, Hyun Suk; Hong, Myeongki; Song, Jae Kwan; Park, Seong Wook; Park, Seung Jung; Kim, Jae Joong.

In: Circulation, Vol. 103, No. 23, 12.06.2001, p. 2784-2787.

Research output: Contribution to journalArticle

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T1 - Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure

AU - Lee, Cheol Whan

AU - Lee, Jung Hee

AU - Lim, Tae Hwan

AU - Yang, Hyun Suk

AU - Hong, Myeongki

AU - Song, Jae Kwan

AU - Park, Seong Wook

AU - Park, Seung Jung

AU - Kim, Jae Joong

PY - 2001/6/12

Y1 - 2001/6/12

N2 - Background - Cerebral metabolic abnormalities were proposed as a potential marker of disease severity in congestive heart failure (CHF), but their prognostic significance remains uncertain. Methods and Results - We investigated the prognostic value of cerebral metabolic abnormalities in 130 consecutive patients with advanced CHF (100 men aged 42.6±11.9 years; left ventricular ejection fraction, 22.2±6.2%). Proton magnetic resonance spectroscopy data were obtained from localized regions (≈8 mL) of the occipital gray matter and the parietal white matter. The primary end point was the occurrence of death after the proton magnetic resonance spectroscopy. During follow-up (18.5±14.4 months), 21 patients died and 15 underwent urgent heart transplantation. In the Cox proportional model, occipital metabolites (N-acetylaspartate, creatine, choline, and myoinositol), parietal N-acetylaspartate level, and the duration of CHF symptoms (> 12 months) were validated as univariate predictors of death. In multivariate Cox analyses, however, the occipital N-acetylaspartate level was an independent predictor of death (hazard ratio, 0.52; 95% CI, 0.41 to 0.67; P<0.001). An analysis with respect to the combined end point of death or urgent transplantation showed similar results. The best cutoff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75% sensitivity and 67% specificity to predict mortality. Conclusions - The occipital N-acetylaspartate level is a powerful and independent predictor of CHF mortality, suggesting that cerebral metabolic abnormalities may be used as a new prognostic marker in the assessment of patients with CHF.

AB - Background - Cerebral metabolic abnormalities were proposed as a potential marker of disease severity in congestive heart failure (CHF), but their prognostic significance remains uncertain. Methods and Results - We investigated the prognostic value of cerebral metabolic abnormalities in 130 consecutive patients with advanced CHF (100 men aged 42.6±11.9 years; left ventricular ejection fraction, 22.2±6.2%). Proton magnetic resonance spectroscopy data were obtained from localized regions (≈8 mL) of the occipital gray matter and the parietal white matter. The primary end point was the occurrence of death after the proton magnetic resonance spectroscopy. During follow-up (18.5±14.4 months), 21 patients died and 15 underwent urgent heart transplantation. In the Cox proportional model, occipital metabolites (N-acetylaspartate, creatine, choline, and myoinositol), parietal N-acetylaspartate level, and the duration of CHF symptoms (> 12 months) were validated as univariate predictors of death. In multivariate Cox analyses, however, the occipital N-acetylaspartate level was an independent predictor of death (hazard ratio, 0.52; 95% CI, 0.41 to 0.67; P<0.001). An analysis with respect to the combined end point of death or urgent transplantation showed similar results. The best cutoff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75% sensitivity and 67% specificity to predict mortality. Conclusions - The occipital N-acetylaspartate level is a powerful and independent predictor of CHF mortality, suggesting that cerebral metabolic abnormalities may be used as a new prognostic marker in the assessment of patients with CHF.

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