Abstract 13608: Chromogranin A Improves Risk Stratification of Chronic Heart Failure Patients, Independently of BNP and LV Function
BACKGROUND: Chromogranin A (CgA), a protein present in the secretory granules of neuroendocrine cells, is increased in chronic heart failure (HF) and CgA levels are associated with adverse outcomes in HF but little is know on the mechanisms underlying this prognostic value. Our aim was to evaluate CgA levels in HF and to analyze the relationship between CgA, BNP, LV function and long-term outcomes.
METHODS: CgA and BNP were measured in 199 fully treated HF pts (mean EF 26±7%). LV function was assessed by echocardiography. The risk adjusted survival was analyzed over a 7-yr follow-up.
RESULTS: Median CgA and BNP were respectively 38.3 UI/L (IQR 18.1-75.1) and 467pg/mL (IQR 196-1268). During follow-up, 127 pts died (worsening HF n=70, sudden death n=33, CV death n=3, other death n=21), 14 pts underwent heart transplant. CgA was associated with age (r = 0.39, p<0.001), glomerular filtration rate (eGFR) (r = -0.62, p<0.001), BNP (r = 0.28, p<0.001), and stroke volume (r = -0.18, p = 0.12). There was no relationship between CgA and NYHA class, pulmonary artery pressure (PAP), E or A waves, and LV mass. In univariate analysis, age (HR 1.03 (1.02-1.05), p<0.001), LVEF (HR 0.97 (0.94-0.99), p=0.008), PAP (HR 1.02 (1.004-1.03), p=0.012), eGFR (HR 0.98 (0.975-0.99), p<0.001), BNP (HR 1.57 (1.37-1.8),p<0.001) and CgA (HR 1.50 (1.27-1.78, p<0.001) predicted all-cause mortality. In multivariate analysis including age, LVEF, eGFR, NYHA class and BNP, CgA remains a strong predictor of long term mortality (HR 1.26 (1.04 -1.52), p=0.018). Higher CgA (>38.3 UI/L) combined with higher BNP (>467pg/mL) was associated with highest all-cause mortality (HR 4.13 (2.55-6.69)), even in the adjusted model (HR 2.49 (1.43-4.36), p=0.001).(Figure)
CONCLUSIONS: CgA could contribute to the neurohumoral response of LV systolic dysfunction. CgA improves risk stratification of chronic HF pts, independently of BNP and LV function and might help to identify pts eligible for more aggressive therapy.
- © 2013 by American Heart Association, Inc.