Homocysteinaemia in Heart Failure Patients in North Eastern Nigeria

Aims: The study was aimed at determining the relationship between plasma homocysteine level and indices of severity in heart failure patients seen at a referral teaching hospital in Gombe, Northeast Nigeria.

Study Design: It was a hospital based cross-sectional study conducted on newly diagnosed heart failure patients managed by the cardiology unit of the Federal Teaching Hospital, Gombe, between May 2015 and December 2015.

Methodology: Ninety newly diagnosed Heart Failure patients who presented to the hospital along with 90 age and sex matched controls were recruited. All the subjects had clinical and Echocardiography evaluations. Homocysteine was assayed using enzyme-linked Immunosorbent Assay (ELISA) Kit for homocysteine designed by Cloud-clone Corp. Data was analyzed using the Statistical Package for Social Sciences for Windows (SPSS), Version 20.

Results: The mean left ventricular ejection fraction (LVEF) of the patients was 35.4±9.81% while that of the control group was 62.1±7.04% (P <0.001). The mean HCY of patients (11.61 ± 8.00 umol/l) was higher than that of controls (10.24±6.98umol.l), though not significantly; P=0.225. The 90th percentile of the homocysteine (HCY) levels in control was 20.9 umol/l. There was no significant relationship between plasma HCY level and the NYHA class of the patients, though post hoc analysis shows HCY level significantly increased from class I to other classes (P=0.034, P=0.020 and P=0.047 respectively). The bivariate correlation between plasma HCY and Echocardiographic LV indices revealed no statistically significant relationship especially with the LVEF (r-0.149, p=0.160). However, the plasma HCY of the heart failure patients increased with increasing left ventricular mass index (LVMI) (r=0.246, p=0.019).

Conclusion: The study found that homocysteine levels are not significantly elevated in heart failure patients compared with healthy matched controls. However, elevated values were found with increasing left ventricular mass index. This might suggest a possible role of homocysteine in cardiac remodeling.