Prognostic impact of chromogranin A in patients with acute heart failure

Abstract

Backgruound: Chromogranin A (CgA) levels have been reported to predict mortality in patients with heart failure. However, information on the prognostic value and clinical availability of CgA is limited. We compared the prognostic value of CgA to that of previously proven natriuretic peptide biomarkers in patients with acute heart failure.

Methods: We retrospectively evaluated 272 patients (mean age, 68.5±15.6 years; 62.9% male) who underwent CgA test in the acute stage of heart failure hospitalization between June 2017 and June 2018. The median follow-up period was 348 days. Prognosis was assessed using the composite events of 1-year death and heart failure hospitalization.

Results: In-hospital mortality rate during index admission was 7.0% (n=19). During the 1-year follow-up, a composite event rate was observed in 12.1% (n=33) of the patients. The areas under the receiver-operating characteristic curves for predicting 1-year adverse events were 0.737 and 0.697 for N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CgA, respectively. During follow-up, patients with high CgA levels (>158 pmol/L) had worse outcomes than those with low CgA levels (≤158 pmol/L) (85.2% vs. 58.6%, p<0.001). When stratifying the patients into four subgroups based on CgA and NT-proBNP levels, patients with high NT-proBNP and high CgA had the worst outcome. CgA had an incremental prognostic value when added to the combination of NT-proBNP and clinically relevant risk factors.

Conclusion: The prognostic power of CgA was comparable to that of NT-proBNP in patients with acute heart failure. The combination of CgA and NT-proBNP can improve prognosis prediction in these patients.

Keywords: Biomarkers; Chromogranin A; Heart failure; Prognosis.

Fig. 1.

Receiver-operating characteristic curve analysis of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and chromogranin A (CgA) in predicting the composite outcome of 1-year death and hospitalization for heart failure. The cutoff values for CgA and NT-proBNP were 158 pmol/L and 3,429 pg/mL, respectively. Areas under the curves for CgA and NT-proBNP levels in predicting 1-year death and hospitalization were 0.697 and 0.737, respectively.

Fig. 2.

Kaplan-Meier survival analysis of the groups according to the levels of chromogranin A (CgA; cutoff value=158 pmol/L) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; cutoff value=3,429 pg/mL).

Fig. 3.

Comparison among the models including the established risk factors, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and chromogranin A (CgA) in predicting 1-year mortality. Model 1 includes age, sex, New York Heart Association (NYHA) class, atrial fibrillation, and de novo heart failure. Model 2: model 1+NT-proBNP. Model 3: model 2+CgA.