title: Plasma levels of alpha-1-antichymotrypsin are elevated in patients with chronic heart failure, but are of limited prognostic value.
abstract: BACKGROUND
  There is increasing interest in utilising novel markers of cardiovascular disease risk in patients with chronic heart failure (HF). Recently, it was shown that alpha-1-antichymotrypsin (ACT), an acute-phase protein and major inhibitor of cathpesin G, plays a role in the pathophysiology of HF and may serve as a marker for myocardial distress.
  
  
  OBJECTIVE
  To assess whether ACT is independently associated with long-term mortality in chronic HF patients.
  
  
  METHODS
  ACT plasma levels were categorised into quartiles. Survival times were analysed using Kaplan-Meier curves and Cox proportional hazards regression, without and with correction for clinically relevant risk factors, including sex, age, duration of HF, kidney function (MDRD), ischaemic HF aetiology and NT-proBNP.
  
  
  RESULTS
  Twenty healthy individuals and 224 patients (mean age 71 years, 72 % male, median HF duration 1.6 years) with chronic HF were included. In total, 159 (71 %) patients died. The median survival time was 5.3 (95 % CI 4.5-6.1) years. ACT was significantly elevated in patients (median 433 μg/ml, IQR 279-680) in comparison with controls (median 214 μg/ml, IQR 166-271; p < 0.001). Cox regression analysis demonstrated that ACT was not independently related to long-term mortality in chronic HF patients (crude HR = 1.03, 95 % CI 0.75-1.41, p = 0.871; adjusted HR = 1.12, 95 % CI 0.78-1.60, p = 0.552), which was confirmed by Kaplan-Meier curves.
  
  
  CONCLUSIONS
  ACT levels are elevated in chronic HF patients, but no independent association with long-term mortality can be established.
authors.affiliation: Department of Cardiology, University Medical Center, Huispostnummer H04.312, PO Box 85500, 3508 GA, Utrecht, the Netherlands, s.lok@umcutrecht.nl.
authors.forename: S I
authors.initials: SI
authors.lastname: Lok
authors.forename: D J
authors.initials: DJ
authors.lastname: Lok
authors.forename: P
authors.initials: P
authors.lastname: van der Weide
authors.forename: B
authors.initials: B
authors.lastname: Winkens
authors.forename: P W
authors.initials: PW
authors.lastname: Bruggink-André de la Porte
authors.forename: P A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: R A
authors.initials: RA
authors.lastname: de Weger
authors.forename: P
authors.initials: P
authors.lastname: van der Meer
authors.forename: N
authors.initials: N
authors.lastname: de Jonge