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. 2017 Sep 8;12(9):e0184333.
doi: 10.1371/journal.pone.0184333. eCollection 2017.

Homoarginine-A prognostic indicator in adolescents and adults with complex congenital heart disease?

Tanja Raedle-Hurst  1 , Marieke Mueller  1 , Andreas Meinitzer  2 , Winfried Maerz  3   4 , Thomas Dschietzig  5   6
Affiliations

Homoarginine-A prognostic indicator in adolescents and adults with complex congenital heart disease?

Tanja Raedle-Hurst et al. PLoS One. .

Abstract

Background: Homoarginine (hArg) has been shown to be of prognostic value in patients with chronic left heart failure. The present study aims to assess the clinical utility and prognostic value of hArg levels in patients with complex congenital heart disease (CHD).

Methods: Plasma hArg levels were measured in 143 patients with complex CHD and compared to clinical status, echocardiographic and laboratory parameters as well as the occurrence of adverse cardiac events.

Results: Median hArg levels were 1.5 μmol/l in CHD patients as compared to 1.70 μmol/l in healthy controls (p = 0.051). Median hArg levels were lowest in patients with Fontan palliation (1.27 μmol/l) and Eisenmenger physiology (0.99 μmol/l) and decreased with the severity of adverse cardiac events with lowest values found in patients prior to death or overt heart failure (0.89 μmol/l). According to ROC analysis, the most important predictors of adverse cardiac events were hArg levels (AUC 0.837, p<0.001, CI 0.726-0.947), NYHA class (AUC 0.800, p<0.001, CI 0.672-0.928) and NT-proBNP levels (AUC 0.780, p<0.001, CI 0.669-0.891). The occurrence of overt heart failure or death due to progressive heart failure were best predicted by NYHA class (AUC 0.945, p<0.001, CI 0.898-0.992), hArg levels (AUC 0.911, p<0.001, CI 0.850-0.971) and NT-proBNP levels (AUC 0.877, p<0.001, CI 0.791-0.962), respectively.

Conclusion: In patients with complex CHD, hArg levels can predict adverse cardiac events as reliably as or even better than NT-proBNP levels and thus might be of prognostic value in this subset of patients.

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Conflict of interest statement

Competing Interests: Winfried Maerz and Thomas B. Dschietzig are employees of Synlab Academy and Immundiagnostik GmbH, respectively. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Boxplots displaying homoarginine levels in healthy controls and patients with various types of complex heart defects.
CRHD, corrected congenital right heart disease; SRV, systemic right ventricle; FONT, Fontan palliation; EIS, Eisenmenger physiology or unrepaired cyanotic heart defect.
Fig 2
Fig 2. Boxplots demonstrating homoarginine levels in patients with different adverse cardiac events.
SVT, supraventricular tachycardia; AF, atrial fibrillation.
Fig 3
Fig 3. Receiver-operating characteristic (ROC) curves comparing sensitivity and specificity of hArg and NT-proBNP levels in predicting adverse cardiac events in general.
AUC, area under the curve.
Fig 4
Fig 4. Receiver-operating characteristic (ROC) curves comparing sensitivity and specificity of hArg and NT-proBNP levels in predicting death due to progressive heart failure or occurrence of overt heart failure.
AUC, area under the curve.
See this image and copyright information in PMC

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