Chromogranin-A in heart failure: An indicator of neuroendocrine activation and a predictive factor for mortality

Heart failure has been defined in many ways and definitions change over time. The multiplicity of definitions reflect the paucity of our understanding of the primary underlying physiology of heart failure and the many diseases for which heart failure is the common end-point. Fundamentally, heart failure represents a failure of the heart to meet the body’s requirement for blood supply for whatever reason. It is thus a clinical syndrome with characteristic features – not a single disease in its own right. The syndrome includes symptoms and signs of organ underperfusion, fluid retention and neuroendocrine activation. The syndrome arises from a range of possible causes of which ischaemic heart disease is the commonest. From the point of view of a clinician, the underlying pathology will determine treatment options and prognosis. The extensive range of possible aetiologies present a diagnostic challenge both to correctly identify the syndrome amongst all other causes of dyspnoea and to identify the aetiology, allowing optimization of treatment.

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Alcohol Intake Is a Predictive Factor of Developing Heart Failure Among Patients With Infective Endocarditis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.821 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Fujiko Morita ◽

Yuji Hirai ◽

Kiyozumi Suzuki ◽

Yuki Uehara ◽

Kazunori Mitsuhashi ◽

...

Keyword(s):

Heart Failure ◽

Infective Endocarditis ◽

Predictive Factor ◽

Alcohol Intake ◽

Developing Heart

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Prognostic value of chromogranin A in chronic heart failure: data from the GISSI-Heart Failure trial

European Journal of Heart Failure ◽

10.1093/eurjhf/hfq055 ◽

2010 ◽

Vol 12 (6) ◽

pp. 549-556 ◽

Cited By ~ 41

Author(s):

Helge Røsjø ◽

Serge Masson ◽

Roberto Latini ◽

Allan Flyvbjerg ◽

Valentina Milani ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Chromogranin A ◽

Prognostic Value ◽

Failure Data ◽

Heart Failure Trial

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Effects of enalapril and neuroendocrine activation on prognosis in severe congestive heart failure (follow-up of the CONSENSUS trial)

The American Journal of Cardiology ◽

10.1016/0002-9149(90)90475-g ◽

1990 ◽

Vol 66 (11) ◽

pp. D40-D45 ◽

Cited By ~ 80

Author(s):

Karl Swedberg ◽

Peter Eneroth ◽

John Kjekshus ◽

Steve Snapinn

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Severe Congestive Heart Failure ◽

Neuroendocrine Activation

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Plasma chromogranin A is a marker of death in elderly patients presenting with symptoms of heart failure

Endocrine Connections ◽

10.1530/ec-14-0017 ◽

2014 ◽

Vol 3 (1) ◽

pp. 47-56 ◽

Cited By ~ 8

Author(s):

Jens P Goetze ◽

Linda M Hilsted ◽

Jens F Rehfeld ◽

Urban Alehagen

Keyword(s):

Heart Failure ◽

Risk Assessment ◽

Elderly Patients ◽

Chromogranin A ◽

Receiver Operating Curve ◽

Step Method ◽

Prognostic Information ◽

Clinical Variables ◽

Risk Of Death ◽

Increased Risk

Cardiovascular risk assessment remains difficult in elderly patients. We examined whether chromogranin A (CgA) measurement in plasma may be valuable in assessing risk of death in elderly patients with symptoms of heart failure in a primary care setting. A total of 470 patients (mean age 73 years) were followed for 10 years. For CgA plasma measurement, we used a two-step method including a screening test and a confirmative test with plasma pre-treatment with trypsin. Cox multivariable proportional regression and receiver-operating curve (ROC) analyses were used to assess mortality risk. Assessment of cardiovascular mortality during the first 3 years of observation showed that CgA measurement contained useful information with a hazard ratio (HR) of 5.4 (95% CI 1.7–16.4) (CgA confirm). In a multivariate setting, the corresponding HR was 5.9 (95% CI 1.8–19.1). When adding N-terminal proBNP (NT-proBNP) to the model, CgA confirm still possessed prognostic information (HR: 6.1; 95% CI 1.8–20.7). The result for predicting all-cause mortality displayed the same pattern. ROC analyses in comparison to NT-proBNP to identify patients on top of clinical variables at risk of cardiovascular death within 5 years of follow-up showed significant additive value of CgA confirm measurements compared with NT-proBNP and clinical variables. CgA measurement in the plasma of elderly patients with symptoms of heart failure can identify those at increased risk of short- and long-term mortality.

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