Osteocalcin is a newly identified type of cytokine secreted by osteoblasts,which has an endocrine function,mediates energy and glycol-lipid metabolism,and is closely related to cardiovascular diseases.In this study,we investigated the value of serum osteocalcin levels in predicting left ventricular systolic dysfunction and cardiac death.A total of 258 patients in the Department of Cardiology were included.Two-dimensional echocardiography was performed in all the subjects.The cardiac death of subjects occurring with a median follow-up of 4.6 years was informed via phone calls or the electronic medical records.The serum osteocalcin levels were measured using electrochemiluminescent immunoassay.We found that the median left ventricular ejection fractions (LVEFs) were 62％ in men and 63％ in women.In the men with a LVEF ＞ 62％,the serum osteocalcin levels were significantly higher than in those with LVEF ≤ 62％ (P =0.042),whereas this difference was absent in the women.Both the serum osteocalcin (β =0.095,P=0.028) and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP;β =-0.003,P＜ 0.01) levels remained independently significantly correlated with LVEF in the men but not in the women.Receiver operating characteristic (ROC) analyses of the men revealed that the serum osteocalcin (P =0.007),serum NT-pro-BNP (P =0.018) and serum osteocalcin + NT-pro-BNP (P ＜ 0.01) levels were all significant in identifying left ventricular systolic dysfunction at baseline,but the pairwise comparisons of the three areas under the curves (AUCs) were all non-significant.The men in the lower osteocalcin level group at baseline suffered a greater risk of future cardiac death than those in the higher osteocalcin level group,whereas the result for NT-pro-BNP exhibited the opposite patte.In conclusion,lower serum osteocalcin levels in the men could identify left ventricular systolic dysfunction and cardiac death in a manner that was not inferior to high serum NT-pro-BNP levels.