Author + information
- Neal Chatterjee,
- Nasrien Ibrahim,
- Timothy Maher,
- Alberto Aimo,
- Jackie Szymonifka,
- Hanna Gaggin,
- Quynh Truong,
- Jagmeet Singh,
- Petr Jarolim and
- James Januzzi
Background: Genetic variation in the hypocretin receptor was recently identified as a predictor of left ventricular reverse remodeling (LV-RR) in heart failure (HF). Whether circulating concentrations of the ligand for the hypocretin receptor (Orexin A) are associated with LV-RR in humans is uncertain.
Methods: In 139 patients (age 68±13 years, LVEF 26±7%) with symptomatic HF undergoing cardiac resynchronization therapy (CRT), we measured Orexin A concentrations at baseline and 6-months after CRT implant. Study endpoints included 6-month LV-RR (defined as a reduction in LVESV ≥15%) and 2-year major adverse cardiac events (MACE).
Results: At baseline, there was no significant correlation between Orexin A and other standard HF biomarkers (ST2, NT-proBNP, galectin-3; all p ≥ 0.30). In univariate analysis, a higher baseline orexin A was linearly associated with LV-RR at 6 months (Figure). Following multivariable-adjustment, an orexin A ≥ 1.27 ng/ml was associated with a 4-fold increased odds of LV-RR (OR 4.43 [95% CI: 1.41-13.91] vs. < 1.27 ng/ml; p=0.01). Six months after CRT implant, a greater increase in orexin A concentration was associated with decreased 2-year MACE (HR 0.65 per log Δ orexin A [95% CI: 0.43-0.97], p=0.04).
Conclusions: Higher Orexin A concentration at the time of CRT implant was associated with a greater likelihood of LV-RR and serial increase in orexin A was associated with improved clinical outcomes. Orexin A may represent a novel predictor of LV-RR and clinical outcomes in HF.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-272
- 2017 American College of Cardiology Foundation