Determination of heavy metal and trace element levelsin congestive heart failure cases presenting to theemergency department

Introduction: Congestive heart failure (CHF) is a clinical syndrome that results from a structural and/or functional cardiac abnormality, which in turn leads to a reduction in cardiac output and/or elevated intracardiac pressures at rest or during stress. Environmental risk factors such as heavy metals and trace element deficiencies may lead to the development or progression of CHF. Levels of heavy metals and trace elements could not be adequately evaluated in CHF cases. The aim of this study was to evaluate heavy metal and trace element levels in CHF patients. Material and Methods: The study was conducted with 38 class 1-2 CHF patients, 38 class 3-4 CHF patients and 36 control groups according to the New York Heart Association (NYHA) classification. Among heavy and toxic metals, Nickel (Ni), Cadmium (Cd), Arsenic (As), Mercury (Hg), Lead (Pb), Aluminium (Al), among trace elements Chromium (Cr), Zinc (Zn), Cobalt (Co), Iron (Fe), Molybdenum (Mo), Calcium (Ca), Manganese (Mn), Copper (Cu), Selenium (Se) and Magnesium (Mg) levels were studied. Heavy metal and trace element levels were compared between CHF and control groups. Results: The mean age was 69.76±1.45 years in NYHA class 1- 2, 72.92±1.43 years in NYHA class 3-4 patients, and 69.17±1.45 years in the control group. The female/male ratio was 1.1 in the NYHA class 1- 2 group, 1.2 in the NYHA class 3-4 group and 1.1 in the control group (p>0.05). NYHA class 1-2 and class 3-4 patients Cd, Mo, Ni, As, Hg, Pb, Ca and Co levels were higher than the control group (in order of; p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.004, p<0.001 and p<0.001). However, Fe, Zn and Cr levels were lower in NYHA class 1-2 and class 3-4 groups than in the control group (in order of; p<0.00, p=0.008 and p<0.001). NYHA class 1-2 patients had lower Se levels than NYHA 3-4 and control group (p<0.001), whereas Al level was higher (p=0.001). While the Mn levels of NYHA class 3-4 patients were higher than the NYHA 1-2 and control groups (p = 0.002), the Mg level was lower (p = 0.014). However, the Cu level was similar between the three groups. Correlation analyses determined that ejection fraction had a positive correlation with Cr and Zn (in order of; r=0.585, p<0.001 and r=0.416, p<0.001); negative correlation with Co, Ni, Cd, As, Hg, and Pb (in order of; r=-0.537, p<0.001; r=-0.652, p<0.001; r=-0.697, p<0.001; r=-0.575, p<0.001; r=-0.616, p<0.001; r=-0.355, p<0.001,). Correlation analyses determined that Pro-BNP had a negative correlation with Cr and Zn (in order of; r=-0.584, p<0.001 and r=-0.431, p<0.001); positive correlation with Co, Ni, Cd, As, Hg, and Pb (in order of; r=0.521, p<0.001; r=0.648, p<0.001; r=0.543, p<0.001; r=0.554, p<0.001; r=0.613, p<0.001; r=0.213, p=0.024 ). Conclusion: It has been determined that heavy metal levels are high and trace element levels are deficient in CHF patients. Our findings indicated that heavy metal exposure and/or trace element abnormalities may be associated with the pathogenesis of CHF. Key Words: Congestive Heart Failure, Exposure, Heavy Metals, Trace Elements