Circulating Procollagen Type III N-Terminal Peptide and Mortality Risk in African Americans With Heart Failure

• Serum procollagen type III N-terminal peptide (PIIINP) is a biomarker of cardiac fibrosis.
• We evaluated the association between serum PIIINP and outcomes in African Americans with New York Heart Association functional class I–III heart failure.
• On multivariate analysis, PIIINP > 4.88 ng/mL was a significant predictor of all-cause mortality (hazard ratio [HR] 5.8, 95% confidence interval [CI] 1.9–17.3; P = .002) and the combined outcome of all-cause mortality or hospitalization for heart failure (HR 2.4, 95% CI 1.2–4.7; P = .016).
• PIIINP may be a useful biomarker for identifying African Americans who may benefit from additional therapy to attenuate cardiac fibrosis and potentially improve outcomes.

BackgroundProcollagen type III N-terminal peptide (PIIINP) is a biomarker of cardiac fibrosis that is associated with heart failure prognosis in whites. Its prognostic significance in African Americans is unknown. We sought to determine whether PIIINP is associated with outcomes in African Americans with heart failure.Methods and ResultsBlood was collected from 138 African Americans with heart failure for determining PIIINP and genetic ancestry, and patients were followed prospectively for death or hospitalization for heart failure. PIIINP was inversely correlated with West African ancestry (R2 = 0.061; P = .010). PIIINP > 4.88 ng/mL was associated with all-cause mortality on univariate (hazard ratio [HR] 4.9, 95% confidence interval [CI] 2.2–11.0; P < .001) and multivariate (HR 5.8; 95% CI 1.9–17.3; P = .002) analyses over a median follow-up period of 3 years. We also observed an increased risk for the combined outcome of all-cause mortality or hospitalization for heart failure with PIIINP > 4.88 ng/mL on univariate (HR 2.6, 95% CI 1.6–5.0; P < .001) and multivariate (HR 2.4, 95% CI 1.2–4.7; P = .016) analyses.ConclusionsHigh circulating PIIINP is associated with poor outcomes in African Americans with chronic heart failure, suggesting that PIIINP may be useful in identifying African Americans who may benefit from additional therapy to combat fibrosis as a means of improving prognosis.