Heat shock protein 27 acts as a predictor of prognosis in chronic heart failure patients

Background: Heat shock proteins (HSPs) represent intracellular mechanisms of stress response. Clinical implications of their (systemic) expression in patients with chronic heart failure (HF) remain inconclusive. Methods: In outpatients with chronic stable HF plasma HSP27 levels were measured using ELISA. Patients were followed for a minimum of one year, and a multivariate Cox proportional hazard model was built for cardiovascular death or HF-associated hospitalisations. Results: A total of 134 patients with chronic HF (mean age 71 +/- 10 years, 34% female, mean LVEF 36 +/- 12%) were included. During a mean follow-up of 527 +/- 260 days, 44 patients (33%) experienced an event. Mean time to event was 350 +/- 236 days. In a Kaplan-Meier survival analysis HSP27 levels above the median (3820 pg/ml) indicate a higher risk for an event (p = 0.03). Increased HSP27 levels remained an independent predictor of events (HR, 2.33 CI 95% 1.12-4.87, p = 0.024) even after adjustment for age, gender, NT-proBNP, LVEF, aetiology, smoking status, kidney function and NYHA class. Conclusions: HSP27 is an independent predictor of prognosis in chronic HF. Our findings suggest that HSP27 may improve risk-stratification in chronic HF beyond known prognostic predictors.