Ceruloplasmin as Redox Marker Related to Heart Failure Severity

This study examined ceruloplasmin levels in patients with HFrEF, depending on cardiopulmonary exercise testing (CPET) parameters; a correlation was found between ceruloplasmin (CER) and iron and hepatic status, inflammatory and redox biomarkers. A group of 552 patients was divided according to Weber’s classification: there were 72 (13%) patients in class A (peak VO(2) > 20 mL/kg/min), 116 (21%) patients in class B (peak VO(2) 16–20 mL/kg/min), 276 (50%) patients in class C (peak VO(2) 10–15.9 mL/kg/min) and 88 (16%) patients in class D (peak VO(2) < 10 mL/kg/min). A higher concentration of CER was found in patients with peak VO(2) < 16 mL/kg/min and VE/CO(2) slope > 45 compared to patients with VE/CO(2) slope < 45 (escectively CER 30.6 mg/dL and 27.5 mg/dL). A significantly positive correlation was found between ceruloplasmin and NYHA class, RV diameter, NT-proBNP, uric acid, total protein, fibrinogen and hepatic enzymes. CER was positively correlated with both total oxidant status (TOS), total antioxidant capacity (TAC) and malondialdehyde. A model constructed to predict CER concentration indicated that TOS, malondialdehyde and alkaline phosphatase were independent predictive variables (R(2) 0.14, p < 0.001). CER as a continuous variable was an independent predictor of pVO(2) ≤ 12 mL/kg/min after adjustment for sex, age and BMI. These results provide the basis of a new classification to encourage the determination of CER as a useful biomarker in HFrEF.