INTRODUCCIÓN: REVISIÓN CRITICA DEL PROBLEMA

RESULTADOS
significant delay in calcium reuptake. As a result, duration of the polarization
phase of cardiac contraction might be expected to increase, thus causing or
worsening diastolic dysfunction.
In the present study, sRAGE levels identified high-risk patients who were older,
more frequently ischemic, with worse functional classes, more prevalent renal
failure and anemia, and higher glycated hemoglobin levels. However, results of
multivariable analysis adjusted for SHFS, BNP, and creatinine levels indicate that
the association of sRAGE with mortality and morbidity are independent of these
clinical conditions and co-morbidities, already considered in the SHFS with the
exception of kidney function and glycated hemoglobin. In fact, sRAGE was the
second more powerful predictor of worse outcomes after SHFS. Interestingly,
renal function expressed as serum creatinine or glomerular filtration rate, which is
a known prognostic predictor in patients with cardiovascular diseases, lost its
significance as a risk marker when adjusted by SHFS, sRAGE, and BNP in our
study. This finding repeats previous evidence from 2 population based
studies 273,277 . This prognostic inferiority of serum creatinine and glomerular
filtration rate can be attributed to several factors. Regarding serum creatinine, it is
known that it does not reflect accurately real renal function, particularly in elderly
women. Concerning glomerular filtration rate, presence of the same variables in
equations for estimation of glomerular filtration rate (Modification of Diet in Renal
Disease and Cockroft-Gault equations) and SHFS likely attenuates the prognostic
capabilities of the former.
Limitations
Our study has several limitations. Although prospective, this is a small-sample
study in a specific CHF population, so further larger-sample investigations are
needed to confirm our results. In contrast, the proportion of high-risk patients
according to SHFS was small; only 25.4% had a risk > 10%. It must be
remembered that the population examined with SHFS came mainly from clinical
trials of outpatients, whereas our patients with an expected worse prognosis were
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