Increased vitamin B12 in heart failure with reduced ejection fraction: A novel marker of disease severity and mortality

Aim: The relationship between elevated vitamin B12 levels and liver damage is well -established, but its association with the severity of heart failure (HF) remains unclear. This study aimed to investigate the prognostic importance of vitamin B12 levels according to disease severity in HF patients with reduced left ventricular ejection fraction (HFrEF). Material and Methods: Two hundred and three consecutive patients with HFrEF were enrolled in this study. Patients were divided into advanced and nonadvanced HF groups based on specific criteria and the primary endpoint was all -cause mortality, which was prospectively assessed. Cox proportional hazards regression analyses were conducted to identify independent predictors of mortality. Results: Of the study patients, 75 (36.9%) had advanced, while 128 (63.1%) had non -advanced HF. The advanced group had significantly higher serum vitamin B12 levels compared to the non -advanced group (p<0.001). Serum vitamin B12 level of > 707.8 pg/mL had a sensitivity of 78.3% and specificity of 76.1% in predicting all -cause mortality (area under the curve=0.863, 95% CI 0.806-0.920, p<0.001). Kaplan -Meier analysis demonstrated that patients with vitamin B12 levels > 707.8 pg/mL had significantly lower survival rates (p < 0.001). In Cox regression analysis, vitamin B12 emerged as an independent predictor of death. Discussion: Elevated serum vitamin B12 levels in HFrEF patients are associated with advanced HF, increased ALT and GGT levels, indicating a cardiohepatic syndrome, and independently predict higher all -cause mortality risk.