Total Plasma Sulfide in Congestive Heart Failure

BackgroundHydrogen sulfide (H2S) has emerged as a third gaseous transmitter in mammals. In animal models of heart failure, treatment with an H2S donor can protect the heart against adverse remodeling and attenuate cardiac dysfunction. The aim was to determine total plasma sulfide in patients with congestive heart failure.Methods and ResultsTotal plasma sulfide was determined in 57 patients on admission to an outpatient clinic or cardiology department. Total plasma sulfide concentrations in these patients was lower compared with a control group (5.32 [2.22, 8.00] μM vs. 8.5 [6.00, 14.00] μM; P = .05). Total plasma sulfide decreased significantly across the New York Heart Association (NYHA) functional classes (II, 5.84 [4.33, 8.00] μM vs. III, 4.67 [4.00, 7.17] μM vs. IV, 2.67 [2.22, 4.31] μM; P = .001). The total plasma sulfide negatively correlated with pro-BNP (R2 cubic, 0.692; P = .001) and pulmonary artery systolic pressure (R2 cubic, 0.569; P = .001). The receiver operating characteristic analysis of the area under the curve for total plasma sulfide as a predictor of mortality was 0.904 (95% CI, 0.822–0.987; P = .001), and of rehospitalization was 0.779 (95% CI, 0.650–0.908; P = .001). Total plasma sulfide was a univariate predictor of mortality (odds ratio, 0.245; 95% CI, 0.108–0.555; P = .001).ConclusionTotal plasma sulfide is negatively related to severity of congestive heart failure: it is lowest in NYHA Class IV and in patients with high pro-BNP and high pulmonary artery pressure. Low total plasma sulfide predicts a higher mortality rate.