Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction.

Huan Zheng,Ye Li,Nanzi Xie

doi:10.1186/0717-6287-47-7

Abstract

BackgroundLeft ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction. As bilirubin is regarded as an important endogenous antioxidant molecule, serum total bilirubin levels were compared between heart failure patients with a preserved left ventricular ejection fraction and normal controls in this study. We recruited 327 heart failure patients with a preserved left ventricular ejection fraction and 200 healthy controls. Patients were divided into 4 subgroups by their comprehensive echocardiographic manifestations, 1-mild, 2-moderate, 3-severe (reversible restrictive), 4-severe (fixed restrictive). Total bilirubin levels were compared using stepwise multiple regressions adjusted for selected factors.ResultsAfter adjusting for gender, age, smoking, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride, serum total bilirubin levels were significantly lower in the heart failure group compared with the control group (P < 0.01). Patients in the subgroup (4-severe) showed significantly (P < 0.05) lower levels of total bilirubin when compared with the subgroup (1-mild).ConclusionsTB level was negatively correlated with left ventricular diastolic dysfunction in heart failure patients with a preserved left ventricular ejection fraction, which might provide a new insight into the complicated mechanisms of heart failure with a preserved left ventricular ejection fraction.

Highlights

Left ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction
Heart failure with a preserved left ventricular ejection fraction (HFpEF) is a clinical syndrome characterized by the symptoms and signs of heart failure (HF), a preserved left ventricular ejection fraction (LVEF ≥ 50%) and abnormal diastolic function [7]
In this study, none of the HFpEF patients had any relevant diseases that could reduce the serum total bilirubin (TB) level, and we found that serum TB levels were significantly lower in HFpEF patients than those in normal controls after adjusting for age, gender, body mass index, smoking, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride

Summary

Introduction

Left ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction. Recent studies have confirmed the correlation between serum bilirubin levels and collateral development in patients with chronic total coronary occlusion [3], peripheral arterial disease [4], amputation events in type-2 diabetes mellitus [5], stroke severity and clinical outcomes [6]. Those results suggested that bilirubin may be a part of a cell defense strategy in those macro- and micro- angiopathies. After a longterm follow-up, they found that the level of malondialdehyde, which was a biomarker of lipid peroxidation, might be a useful parameter for monitoring and planning management of chronic HF patients [13]

Methods

Results

Discussion

Conclusion