Total plasma sulfide in congestive heart failure.

BACKGROUND: Hydrogen sulfide (H(2)S) has emerged as a third gaseous transmitter in mammals. In animal models of heart failure, treatment with an H(2)S donor can protect the heart against adverse remodeling and attenuate cardiac dysfunction. The aim was to determine total plasma sulfide in patients with congestive heart failure. METHODS AND RESULTS: Total plasma sulfide was determined in 57 patients on admission to an outpatient clinic or cardiology department. Total plasma sulfide concentrations in these patients was lower compared with a control group (5.32 [2.22, 8.00] µM vs. 8.5 [6.00, 14.00] µM; P = .05). Total plasma sulfide decreased significantly across the New York Heart Association (NYHA) functional classes (II, 5.84 [4.33, 8.00] µM vs. III, 4.67 [4.00, 7.17] µM vs. IV, 2.67 [2.22, 4.31] µM; P = .001). The total plasma sulfide negatively correlated with pro-BNP (R(2) cubic, 0.692; P = .001) and pulmonary artery systolic pressure (R(2) cubic, 0.569; P = .001). The receiver operating characteristic analysis of the area under the curve for total plasma sulfide as a predictor of mortality was 0.904 (95% CI, 0.822-0.987; P = .001), and of rehospitalization was 0.779 (95% CI, 0.650-0.908; P = .001). Total plasma sulfide was a univariate predictor of mortality (odds ratio, 0.245; 95% CI, 0.108-0.555; P = .001). CONCLUSION: Total plasma sulfide is negatively related to severity of congestive heart failure: it is lowest in NYHA Class IV and in patients with high pro-BNP and high pulmonary artery pressure. Low total plasma sulfide predicts a higher mortality rate.

Fat-Free Mass and Body Fat in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention.

There are no data on the effects of fat-free mass (FFM) and body fat (BF) on prognosis in patients with myocardial infarction (MI). We investigated the effects of FFM and BF (which were estimated using formulas rather than direct measurements) on 30-day and long-term all-cause mortality in patients with MI who underwent percutaneous coronary intervention. We analyzed data from 6,453 patients with MI. The patients were divided into 2 categories (high/low) according to the fat-free mass index (FFMI) and 2 categories (low/high) according to the BF. The resultant 4 patient groups: HighFFMI-LowBF, HighFFMI-HighBF, LowFFMI-LowBF, and LowFFMI-HighBF, were compared. The lowest crude mortality after 30 days and in the long term was observed in the HighFFMI-LowBF group (3.0%,9.8%, respectively), followed by the HighFFMI-HighBF group (6.6%, 27.0%, respectively), the LowFFMI-LowBF group (10.4%, 36.0%, respectively), and the LowFFMI-HighBF group (14.7%, 56.8%, respectively). The difference was significant (p <0.0001), as was the difference between groups. After adjustment, the FFMI-BF groups independently predicted 30-day mortality (p = 0.003), but the risk was similar in all groups. Compared with the HighFFMI-LowBF group, the long-term mortality risk was similar in the HighFFMI-HighBF group (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.84 to 1.47, p = 0.47), but the LowFFMI-LowBF and LowFFMI-HighBF patients had a higher risk (HR 1.59, 95% CI 1.20 to 2.11, p = 0.001, HR 1.40, 95% CI 1.03 to 1.91, p = 0.033, respectively). Body composition predicted mortality better than body mass index in patients with MI. Mortality appeared to be inversely related to FFM, with patients with low FFM and low BF having a particularly high mortality risk. The body composition groups also confirmed the obesity paradox.