Abstract 11434: Soluble Programed Cell Death Ligand-1 is Associated With Future Heart Failure Hospitalization in Patients With Atherosclerotic Cardiovascular Disease

Abstract

<Background> Heart failure following atherosclerotic cardiovascular disease (ASCVD) is a significant problem worldwide. Chronic inflammation is a crucial pathogenesis both in heart failure and ASCVD. Programmed cell death-1(PD-1) and its ligand (PD-L1) regulate immune response through T cell proliferation and secretion of cytokines as immune checkpoint protein. However, the prognostic significance of immune checkpoint protein on ASCVD and heart failure is unknown. We investigated the association between the serum levels of PD-L1 (sPD-L1) and heart failure-related events in patients with ASCVD. <Methods> We prospectively measured sPD-L1 using a commercially available enzyme-linked immunosorbent assay kit in patients with ASCVD admitted to Kumamoto University Hospital. The occurrence of cardiovascular events was observed between December 2017 and January 2020. The primary outcome was heart failure hospitalization. We excluded patients complicated with cancer, hemodialysis, active collagen diseases, and inflammatory diseases. <Results> We screened 792 patients with ASCVD. 200 patients met exclusion criteria. Finally, 592 patients with ASCVD were enrolled. Median follow-up period was 490 days. A total of 37 events were recorded during study period. Kaplan-Meier curve revealed that the higher sPD-L1 group (sPD-L1≧136pg/dL, median) showed significantly higher rate of heart failure hospitalization than the lower sPD-L1 group (9.1% vs. 3.4%, log-rank test: P =0.006). Univariate Cox proportional hazards analysis identified estimated glomerular filtration rate (eGFR), B-type natriuretic peptide (BNP), and higher sPD-L1 as significant factors associated with heart failure hospitalization. Multivariable Cox proportional hazards analysis by significant factors from univariate analysis identified that higher sPD-L1 [hazard ratio (HR): 1.003, 95% confidence interval (CI): 1.000-1.005, P =0.042) and BNP (HR: 1.001, 95% CI: 1.000-1.001, P =0.007)] were significantly and independently associated with heart failure hospitalization. <Conclusion> The higher levels of sPD-L1 were significantly associated with future heart failure hospitalization in patients with ASCVD.