Abstract 18743: Diagnostic and Prognostic Value of Gremlin-1 In Patients With Acute Congestive Heart Failure
PURPOSE: Gremlin-1 is an inhibitor of bone morphogenetic proteins regulating cardiomyocyte formation. Gremlin-1 is involved in fibrotic and inflammatory processes and correlates with the degree of cardiac fibrosis. Congestive heart failure is characterized by an adverse structural remodelling of the myocardium. This study evaluates serum levels of Gremlin-1 in patients being suspected of acute congestive heart failure (aCHF) in the emergency department.
PATIENTS AND METHODS: 401 patients presenting with symptoms of acute dyspnea and/or peripheral edema in the emergency department were evaluated. Patients were followed up to five years after presentation in the emergency department. Blood samples for measurement of Gremlin-1 (Human Grem1 ELISA®, USCN Life Science Inc.), Osteopontin (OPN) (R&D Systems, Inc.) and NT-proBNP (Dimension System, Siemens AG) were collected at the initial clinical presentation.
RESULTS: Median Gremlin-1 levels were significantly higher in patients with aCHF (291 ng/ml, n=122) as compared to patients without aCHF (205 ng/ml, n=279) (p=0.0001). Median Gremlin-1 correlated significantly with OPN (r=0.16, p=0.002) and NT-proBNP (r=0.24, p=0.001). Median Gremlin-1 levels were higher in patients with a left ventricular (LV) dysfunction (258 ng/ml, n=91) compared to patients with a normal LV function (221 ng/ml, n=135) (p=0.05). Median Gremlin-1 levels were higher in ACC/AHA class C/D patients (246 ng/ml, n=215) compared to class A/B patients (208 ng/ml, n=133) (p=0.02). Median Gremlin-1 levels were significantly higher in patients being rehospitalized because of aCHF (1 year: 477 ng/ml (n=34) vs. 215 ng/ml (n=367), p=0.0001; 5 years: 301 ng/ml (n=73) vs. 212 ng/ml (n=328); p=0.001) and in patients who died during follow-up (1 year: 255 ng/ml (n=57) vs. 218 ng/ml (n=344), p=0.04; 5 years: 229 ng/ml (n=129) vs. 210 ng/ml (n=272); p=0.08).
CONCLUSIONS: Gremlin-1 serum levels were increased in patients suffering from aCHF. Gremlin-1 correlated with OPN, NT-proBNP, functional NYHA and structural AHA/ACC classification. Increased Gremlin-1 levels were associated with long-term aCHF related rehospitalization and all-cause mortality after 5 years.
- © 2013 by American Heart Association, Inc.