title: Serum pregnancy-associated plasma protein a in patients with heart failure.
abstract: BACKGROUND
  Pregnancy-associated plasma protein A (PAPP-A) proteolyzes insulin-like growth factor (IGF)-binding proteins and thus increases IGF-1 bioactivity. PAPP-A has been reported to be involved in various pathophysiologic abnormalities; however, the clinical significance of PAPP-A has not been examined in cases of heart failure (HF). We hypothesized that PAPP-A levels might be correlated with the severity of HF.
  
  
  RESULTS
  PAPP-A and B-type natriuretic peptide (BNP) levels were measured in 262 subjects (182 HF patients and 80 control subjects). PAPP-A levels were higher in patients with HF than in control subjects and increased with advancing New York Heart Association functional class. There were 53 cardiac events during a mean follow-up period of 796 days. PAPP-A levels were higher in patients with cardiac events than in event-free patients. Patients were divided into 3 groups on the basis of their PAPP-A and BNP levels. Kaplan-Meier analysis demonstrated that the group with both high BNP with high PAPP-A had a significantly higher cardiac event rate than other groups.
  
  
  CONCLUSIONS
  Serum PAPP-A levels were related to the severity of HF and associated with a high risk for adverse cardiac events in HF patients, suggesting that PAPP-A might be involved in the pathogenesis of HF.
authors.affiliation: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Funayama
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shishido
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Netsu
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Ishino
authors.forename: Toshiki
authors.initials: T
authors.lastname: Sasaki
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Katoh
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Joji
authors.initials: J
authors.lastname: Nitobe
authors.forename: Tetsu
authors.initials: T
authors.lastname: Watanabe
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007564:Japan; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D012372:ROC Curve; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D020097:Natriuretic Peptide, Brain; D011266:Pregnancy-Associated Plasma Protein-A