title: Prognostic Usefulness of Proenkephalin in Stable Ambulatory Patients With Heart Failure.
abstract: Patients with heart failure have a poor prognosis, yet outcomes might be improved by early identification of risk. Proenkephalin (proENK), a novel biomarker, is a stable surrogate marker for endogenous enkephalins and is an independent predictor of heart failure and death in patients who had an acute myocardial infarction. This is the first study to evaluate the prognostic utility of this biomarker in stable ambulatory patients. We conducted a 4-year single-center prospective cohort study of 200 patients who were referred for an outpatient echocardiogram. Blood samples were obtained to analyze levels of proENK at the time of the initial echocardiogram. Patients were evaluated for the combined end point cardiovascular-related hospital admission or death. Participants with higher proENK levels were older and had higher serum creatinine and lower estimated glomerular filtration rate, lower ejection fraction, and higher rates of hypertension and diabetes (p ≤0.009). Highest proENK tertile had a hazard ratio of 3.0 (95% confidence interval 1.4 to 6.7) compared with the first tertile (p <0.007) for the primary end point. In conclusion, proENK demonstrated significant prognostic utility for cardiovascular-related hospital admission or death.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, California. Electronic address: barbit@ucsd.edu.
authors.forename: Boris
authors.initials: B
authors.lastname: Arbit
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Nick
authors.initials: N
authors.lastname: Marston
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, California.
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Medicine, Coronary Care Unit and Heart Failure Program, San Diego Veterans Affairs Medical Center, San Diego, California.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Lee
authors.affiliation: Department of Medicine, Coronary Care Unit and Heart Failure Program, San Diego Veterans Affairs Medical Center, San Diego, California.
authors.forename: Hermineh
authors.initials: H
authors.lastname: Aramin
authors.affiliation: Department of Medicine, Coronary Care Unit and Heart Failure Program, San Diego Veterans Affairs Medical Center, San Diego, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: Department of Medicine, Coronary Care Unit and Heart Failure Program, San Diego Veterans Affairs Medical Center, San Diego, California.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002140:California / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D004745:Enkephalins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D004745:Enkephalins; D011498:Protein Precursors; C029992:proenkephalin