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Catestatin (CST) is a fragment of chromogranin A with a broad spectrum of activities in cardiovascular system. We have noticed that level of plasma CST increased in chronic heart failure patients. And plasma CST gradually increased in patients from NYHA class I to class IV. Thus CST might be a novel biomarker in heart failure. However, the potential relationship of plasma CST and adverse prognosis of patients is unknown. The aim of this study is to investigate the potential prognostic predictive ability of plasma CST in heart failure patients. Our hypothesis was that elevated plasma CST might be an indicator of adverse prognosis of heart failure.
We measured baseline plasma CST with enzyme-linked immune-sorbent assay in 202 heart failure patients admitted in our center. These patients were followed up for a mean 52.5 months by visiting or telephone contact to acquire major cardiac adverse events. We focused on the two major events, i.e. all-cause deaths and cardiac deaths. The relationship between baseline plasma CST level and occurrence of these events were analyzed.
There were 59 cases of all-cause deaths at the end of follow-up, and among them included 49 cases of cardiac deaths. The levels of plasma CST were higher in patients with all-cause death and cardiac death than in survivors (1.06(0.66-1.82) ng/ml vs. 0.75(0.58-1.12) ng/ml, p=0.005; and 1.18(0.69-1.83) ng/ml vs. 0.75(0.58-1.12) ng/ml, p=0.002, respectively). In univariate COX regression, higher plasma CST predicted increased risk of all-cause and cardiac death, the hazard ration (HR) was 1.81 (95% CI, 1.39-2.36, p<0.001) and 1.89 (95% CI, 1.43-2.50, p<0.001), respectively. In multivariate COX regression, after adjusted for covariates including age, gender, plasma BNP level, NYHA function class and LVEF, increased CST concentration remained as an independent risk factor for cardiac death (HR=1.52, 95% CI: 1.02-2.25, p=0.039). For all-cause death, it had marginally significance (HR=1.43, 95%CI: 1.00-2.05, p=0.051). The new risk-predictive model with CST as a parameter showed superiority over the old one for both outcomes with ANOVA and likelihood ratio test (p=0.008 and p=0.04 respectively). Concurrent elevation of plasma BNP and CST predicted the highest risk for both all-cause and cardiac deaths (HR=5.18 (95% CI: 1.94-13.87, p=0.001) and HR=9.19 (95% CI: 2.75-30.78, p<0.001)).
Plasma CST predicted all-cause and cardiac deaths in heart failure patients. Large-scale studies are needed to verify the value of plasma CST in predicting prognosis of heart failure.