Published Online
on May 14, 2009

A more recent version of this article appeared on July 1, 2009

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Original Article

Prevalence of elevated gamma-glutamyltransferase (GGT) and prognostic significance of GGT in chronic heart failure

Gerhard Poelzl¹; Christian Eberl; Helene Achrainer; Jakob Doerler; Otmar Pachinger; Matthias Frick and Hanno Ulmer

Innsbruck Medical University, Austria

¹ E-mail: gerhard.poelzl{at}uki.at

Background—Serum gamma-glutamyltransferase (GGT) is associated with incident cardiovascular diseases and is a potential risk factor for disease mortality. We aimed to investigate the relevance of circulating GGT in chronic heart failure.

Methods and Results—From 2000 to 2007 clinical and laboratory variables of 1033 consecutive outdoor heart failure patients were evaluated. Follow-up (mean 34.4 months) was available in 998 patients. The endpoint was defined as death from any cause or heart transplantation. A forward stepwise Cox proportional hazards regression model for sex-stratified data was used.

Prevalence of elevated GGT was 42.9% in men (GGT >65 U/l) and 50.2% in women (GGT >38 U/L), which was higher than for sex and age-matched healthy subjects (18.6% in men, 19.2% in women) derived from a large historical control group. GGT was associated with severity of heart failure as assessed by NYHA class, LV ejection fraction, and NT-proBNP. The endpoint was recorded in 302 patients. Compared to the lowest GGT quintile, sex-stratified HR for patients in the highest quintile was 2.88 (1.99 - 4.17) in the univariate model and 1.87 (1.28 - 2.74) in the adjusted model (p<0.001). Corresponding five-year cumulative event rates were 47% and 74%, respectively. Adjusted HR for elevated GGT was 2.9 (1.64 - 5.17) for patients in NYHA I/II, and 1.2 (0.75 - 2.05) for patients in NYHA III/IV, respectively (p=0.003, for the GGT - NYHA class interaction).

Conclusions—Prevalence of elevated GGT is high in chronic heart failure patients. GGT levels are associated with disease severity. Increased GGT is an independent predictor of death or heart transplantation. GGT may provide additional prognostic information, especially in patients with mild heart failure.

Key Words: enzymes • heart failure • liver • prognosis • gamma-glutamyltransferase