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

BackgroundThe 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.Methods137 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.ResultsDecedents (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).ConclusionsOur 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.