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Original Research: BIOMARKERS AND HEART FAILURE |

Prognostic Value of Pigment Epithelium-Derived Factor in Patients With Advanced Heart Failure

Kathrin Rychli, PhD; Alexander Niessner, MD; Philipp J. Hohensinner, PhD; Kariem Mahdy Ali, MD; Christoph Kaun; Stephanie Neuhold, MD; Gerlinde Zorn; Bernhard Richter, MD; Martin Hülsmann, MD; Rudolf Berger, MD; Deddo Mörtl, MD; Kurt Huber, MD; Gerald Maurer, MD; Richard Pacher, MD; Johann Wojta, PhD
Author and Funding Information

From the Division of Cardiology, Department of Internal Medicine II (Drs Rychli, Niessner, Hohensinner, Mahdy Ali, Neuhold, Richter, Hülsmann, Berger, Mörtl, Maurer, Pacher, and Wojta; Mr Kaun; and Ms Zorn), Medical University of Vienna; and Department of Cardiology and Emergency Medicine (Dr Huber), Wilhelminen Hospital, Vienna, Austria.

Correspondence to: Alexander Niessner, MD, Division of Cardiology, Department of Internal Medicine II, Waehringer Guertel 18-20, 1090 Vienna, Austria; e-mail: alexander.niessner@meduniwien.ac.at


Funding/Support: This project was supported by the Jubiläumsfond of the Austrian National Bank, the Ludwig Boltzmann Cluster for Cardiovascular Research, and the Association for the Promotion in Research in Arteriosclerosis, Thrombosis, and Vascular Biology.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):656-664. doi:10.1378/chest.09-2739
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Objective:  Whereas angiogenesis, the formation of new blood vessels from preexisting vessels, may be beneficial in restoring failing myocardium, apoptosis may contribute to the progression of heart failure (HF). We investigated the role of pigment epithelium-derived factor (PEDF), a recently discovered antiangiogenic factor with additional proapoptotic effects, in patients with advanced HF.

Methods:  We assayed PEDF levels in 351 patients with advanced HF at baseline. During the median follow-up time of 16 months, 50% of patients experienced the composite end point of rehospitalization and/or death.

Results:  The risk of a clinical event increased with concentrations of the antiangiogenic marker PEDF, with a 1.94-fold higher risk in the third tertile compared with the first tertile (95% CI, 1.33-2.84). This association remained significant after adjustment for B-type natriuretic peptide (BNP) and other risk factors in a Cox regression model (P = .015). Experimental data revealed that PEDF may contribute to the progression of HF by inducing apoptosis in human cardiac myocytes and fibroblasts via activation of caspase 3.

Conclusions:  We suggest a role of PEDF in the progression of HF by inducing apoptosis of human cardiac myocytes and fibroblasts. Our clinical data suggest that PEDF concentrations may have the potential to become a valuable marker of the prognosis of HF, in addition to BNP.

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