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Mitochondrial DNA predicts mortality in acute but not in chronic heart failure

Session Moderated Poster Session 4 - Acute Heart Failure/ Acute Cardiac Care

Speaker Konstantin A Krychtiuk

Event : Acute Cardiovascular Care 2018

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Biomarkers
  • Session type : Moderated Posters

Authors : KA Krychtiuk (Vienna,AT), R Wurm (Vienna,AT), S Ruhittel (Vienna,AT), M Lenz (Vienna,AT), K Huber (Vienna,AT), J Wojta (Vienna,AT), G Heinz (Vienna,AT), M Huelsmann (Vienna,AT), WS Speidl (Vienna,AT)

Authors:
KA Krychtiuk1 , R Wurm1 , S Ruhittel1 , M Lenz1 , K Huber2 , J Wojta1 , G Heinz1 , M Huelsmann1 , WS Speidl1 , 1Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology - Vienna - Austria , 2Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine - Vienna - Austria ,

Citation:
European Heart Journal Supplement ( 2018 ) 7 ( Supplement ), S33

Background: Acute heart failure (AHF) and cardiogenic shock (CS) are associated with a poor short-term outcome, while patients with chronic heart failure (CHF) exhibit a poor long-term prognosis. Tissue hypoxia may lead to cellular damage and the release of intracellular mitochondrial DNA (mtDNA), which may activate the immune system due to its resemblance to bacterial DNA.
Purpose: The aim of this study was to analyze circulating levels of mtDNA as a possible predictor of outcome in patients with AHF/CS and CHF.
Methods: Plasma levels of circulating mtDNA were measured in 90 consecutive patients with CS or severe AHF admitted to our ICU and in 109 consecutive patients with CHF at our HF outpatient department.
Results: Patients in the ICU group were 64.7 (49.4-74.3) years old and median NT-proBNP levels were 4986 (1525 – 23842) pg/mL. 30-day survival was 64.4%. In the CHF group, median age was 63 (IQR 52-72) years. 49.5 % of patients had ischemic and 50.5 % had a non-ischemic etiology of CHF. 38.5 % were in NYHA class III/IV, and patients had a median NT-proBNP level of 1025 (IQR 450-3480) pg/mL.
Patients with AHF or CS showed significantly higher circulating levels of mtDNA as compared to patients with CHF (27.0 IQR 8.2 – 52.2 ng/mL vs. 14.5 IQR 8.5 – 25.4 ng/mL, p < 0.005). In CHF patients, mtDNA levels were associated with NYHA functional class but did not differ according to HF etiology and outcome. On the contrary, in patients with severe AHF and CS, mtDNA levels were significantly higher in patients that died within 30 days after ICU admission (30.6 IQR 13.0 – 90.1 ng/mL vs. 22.8 IQR 6.4 – 41.6 ng/mL, p < 0.05); patients with plasma levels of mtDNA in the highest quartile (mtDNA>50.9 ng/mL) had a 3.1-fold risk (p=0.002) of dying.
Conclusions: Circulating levels of mtDNA predict mortality in patients with severe AHF and CS but are not associated with outcome in patients with CHF. Reduced tissue perfusion with release of mtDNA may play a role within the pathophysiology of AHF and advances stages of CHF.

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