title: Plasma chromogranin A is a marker of death in elderly patients presenting with symptoms of heart failure.
abstract: 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.
authors.affiliation: Department of Clinical BiochemistryRigshospitalet, University of Copenhagen, Copenhagen, Denmark Division of Cardiovascular MedicineDepartment of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Goetze
authors.forename: Linda M
authors.initials: LM
authors.lastname: Hilsted
authors.forename: Jens F
authors.initials: JF
authors.lastname: Rehfeld
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen