Rössig L et al. (2004) The pro-apoptotic serum activity is an independent mortality predictor of patients with heart failure. Eur Heart J 25: 1620–1625

Serum of patients with heart failure (HF) can induce apoptosis in cultured endothelial cells. This observation prompted Rössig and colleagues to consider whether pro-apoptotic activity is related to disease progression.

Serum samples were obtained from 48 patients with HF and systemic pro-apoptotic activity was determined using an ex vivo cell culture assay. Patients were then followed up for a minimum of 30 months, with all-cause mortality the single endpoint of the study.

A total of 16 patients died during follow-up and 11 received a heart transplant and were considered as survivors. Mortality was significantly higher in patients whose serum pro-apoptotic activity was above the median value (P < 0.02). Multivariate regression analysis revealed that pro-apoptotic serum activity was an independent predictor of death (HR 1.85 per %, P = 0.008), as were elevated pro-BNP levels (HR 9.35 per log[pro-BNP], P = 0.001) and low blood pressure (HR 0.96 per mmHg, P = 0.041). The sensitivity and specificity of serum pro-apoptotic activity analysis for predicting mortality were similar to those for pro-BNP serum levels.

Concluding that pro-apoptotic serum activity is an independent predictor of HF mortality, the authors suggest that it may provide a measure of the effects of systemic inflammation in these patients.