Chromogranin A and C-terminal endothelin-1 precursor fragment add independent prognostic information to amino-terminal proBNP in patients with acute destabilized heart failure.

Abstract

BACKGROUND:

The aim of this study was to evaluate the prognostic value of chromogranin A (CgA) and C-terminal endothelin-1 precursor fragment (CT-proET-1) in patients with acute destabilized heart failure.

METHODS:

137 consecutive patients with acute destabilized heart failure attending the emergency department of a tertiary care hospital were prospectively enrolled. Plasma concentrations of CgA, CT-proET-1, and amino-terminal proBNP (NT-proBNP) were measured at baseline. The endpoint was defined as all-cause mortality; the study participants were followed up for 365 days.

RESULTS:

Decedents (n=41) had higher median plasma concentrations of CgA (9.7 vs. 6.0 nmol/L; p=0.002), CT-proET-1 (120 vs. 72 pmol/L; p=0.006), and NT-proBNP (5112 vs. 2610 ng/L; p<0.001) at baseline than survivors (n=96). Applying Cox proportional-hazards regression analyses, increased CgA (>6.6 nmol/L), CT-proET-1 (>79 pmol/L), and NT-proBNP (>3275 ng/L) revealed significant risk ratios of 1.96 (95% CI, 1.04-3.70) for CgA, 2.56 (95% CI, 1.33-4.95) for CT-proET-1, and 2.05 (95% CI, 1.09-3.87) for NT-proBNP. When the cohort was stratified according to median CgA and NT-proBNP concentrations, and to median CT-proET-1 and NT-proBNP concentrations, respectively, Cox proportional-hazards regression analyses showed the highest risk for death in patients with both increased CgA and NT-proBNP (risk ratio, 3.65; 95% CI, 1.44-9.28), and increased CT-proET-1 and NT-proBNP (risk ratio, 4.03; 95% CI, 1.61-8.88).

CONCLUSIONS:

Our study demonstrates that increased CgA and CT-proET-1 plasma concentrations at the initial presentation of patients with acute destabilized heart failure in the emergency department add independent prognostic information in addition to NT-proBNP measurement.

• Authors: Benjamin Dieplinger, Alfons Gegenhuber, Joachim Struck, Werner Poelz, Werner Langsteger, Meinhard Haltmayer, Thomas Mueller
• Journal: Clinica chimica acta; international journal of clinical chemistry (Clin Chim Acta) Vol. 400 Issue 1-2 Pg. 91-6 (Feb 2009) ISSN: 1873-3492 [Electronic] Netherlands
• PMID: 19000665 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Chromogranin A
• Endothelin-1
• Peptide Fragments
• Protein Precursors
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Chromogranin A (blood)
• Data Collection
• Endothelin-1 (chemistry)
• Female
• Heart Failure (blood, diagnosis, mortality)
• Humans
• Male
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Prognosis
• Protein Precursors (chemistry)
• Survival Rate