Prognostic value of serum brain-derived neurotrophic factor levels in patients with Chagas cardiomyopathy

• Main Authors: Henrique S Costa, Marcia Maria O Lima, Pedro Henrique S Figueiredo, Patrícia M Martinelli, Elizabeth RS Camargos, Ana Thereza Chaves, Maria Carmo Pereira Nunes, Manoel Otavio C Rocha
• Format: Article
• Language: English
• Published: Instituto Oswaldo Cruz, Ministério da Saúde 2018-08-01
• Series: Memórias do Instituto Oswaldo Cruz.
• Subjects: brain-derived neurotrophic factor; Chagas cardiomyopathy; echocardiogram; exercise testing; prognosis
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762018001000300&lng=en&tlng=en

BACKGROUND Serum brain-derived neurotrophic factor (BDNF) levels have been shown to be lower in patients with Chagas cardiomyopathy (ChC) than in patients with non-dilated chagasic cardiomyopathy. However, its prognostic value was not established in patients with ChC. METHODS Forty-nine patients with ChC (50 ± 7 years, New York Heart Association “NYHA” I-III); were evaluated by echocardiography, exercise testing, and blood analysis. Serum BDNF levels were determined using enzyme-linked immunosorbent assay sandwich. Patients were followed-up, and cardiac death was considered the end-point. The survival analyses were performed using Kaplan-Meier and Cox regression. RESULTS After 39 ± 14 months of follow-up, 12 patients (25%) died. The concentration of 2.5 ng/mL was the optimal cut-off value to predict survival with significant difference between the groups with low (≤ 2.5 ng/mL) and high (> 2.5 ng/mL) BDNF levels (p = 0.006). Lower serum BDNF levels (hazards ratio (HR) 1.1, 95% confidence interval (CI) 1.1-1.4; p = 0.001), peak oxygen uptake (HR 1.2, 95% CI 1.0-1.3; p = 0.009), and left ventricular ejection fraction (HR 0.8, 95% CI 0.7-0.9; p = 0.001) were the independent predictors of survival. The combination of low serum BDNF levels and reduced left ventricular ejection fraction were highly predictive of death (HR 5.6, 95% CI: 1.2-9.7; p = 0.026). CONCLUSION In patients with ChC, reduced serum BDNF levels, especially if associated with systolic function, may provide useful prognostic information.