| Objective:Our aim is to study the associations between plasma chromogranin A(CGA) levels and cardiac structure、cardiac function index in patients with chronic heart failure and to explore its role in the development of heart failure and the clinical prognostic value.Methods From the first affiliated hospital of soochow university took 44 patients with heart failure.The patients based on NYHA grading were divided into four groups, cardiac function I levels group 4 cases,II levels group 10 cases,III level group 17 cases,IV levels group 13 cases.Collect general information in all patients,the parameters of left ventricle end-diastolic diameter(LVEDD),left ventricle ejection fraction(EF) were detected with echocardiography.Levels of CGA and NT-pro BNP were examined before and after one week formal anti-heart failure treatment.Plasm CGA and NT-pro BNP were detected by enzyme linked immunosorbent assay(ELISA).Compared the plasma CGA and NT-pro BNP levels in each group,observed the plasma CGA and NT-pro BNP changes and mutual relationship between different NYHA classifications.One hundred and twenty days after discharge,follow-up was performed to the chronic heart failure patients to document the adverse events,such as death or readimission.Results:1.CGA and NT-pro BNP showed remarkable increase in patients with NYHA Class Ⅲ or Ⅳ HF[(11504.59±4623.26)pg/ml、(21216.00±5762.97)pg/ml、(215.65±16.99)ng/ml、(310.46±47.35)ng/ml] compared with these of the patients of class Ⅱ[(1766.50±331.17) pg/ml、(124.70±16.61)ng/ml](P<0.05).In addition,CGA and NT-pro BNP in patients with NYHA Class Ⅱ[(1766.50±331.17)pg/ml、(124.70±16.61)ng/ml] showed remarkable higher than those of Class Ⅰpatients[(989.75±179.50)pg/ml、(99.75±5.91)ng/ml](P<0.05). 2.Levels of CGA and NT-pro BNP [(15127.27±9285.89) pg/ml、(273.33±71.16) ng/ml ]inpatients with left ventricular ejection fraction(EF) ≤40% showed significant increase compared with those of EF>40%[(7816.97±5937.79) pg/ml 、(180.97±68.59) ng/ml](P<0.05).CGA levels of patients with left ventricular end-diastolic dimension(LVEDD) [(10951.92±8938.50)pg/ml、(315.83±45.07)ng/ml] more than 60 mm were higher than those of LVEDD less than 60mm[(10068.06±7698.02)pg/ml、(173.69±53.37)ng/ml]. 3.Correlation analysis indicated CGA level was positively correlated with NYHA classification and LVEDD(r=0.92,P<0.05;r=0.95,P<0.05),and positively correlated with EF(r=-0.63,P<0.05).No correlations were detected between NT-pro BNP、LVEDD and NYHA classification(P>0.05). 4.After anti-heart failure treatment, NT-pro BNP and CGA concentrations showed significant reduction in effective group[( 9123.27±8139.79) pg/ml(179.52±93.07) ng/ml)] compared with baseline level[(10309.11±7957.33)pg/ml、(212.45±81.69)ng/ml](p<0.05). 5.During the 120 days telephone follow-up, CGA levels[(265.92±87.81) ng/ml] of patients with adverse events were higher than those without adverse events[(192.41±70.71)ng/ml]( P=0.006),while NT-pro BNP between two groups [(12225.92±9103.67)pg/ml 、(9590.31±7514.41)pg/ml] had no significant difference(P=0.334).Conclusion:1.CGA level increases gradually with the deterioration of heart function,indicating that CGA is associated with the extent of heart failure and also as an sensitive index to evaluating cardiac function. 2.The levels of plasma CGA have a good correlation with EF in patients with heart failure and it is more sensitive to the changes in left ventricular function. It also have a relatively good correlation with LVEDD,suggesting that plasma CGA levels may have a good correlation with left ventricular remodeling. 3.Plasm CGA decreases in patients who feel better after anti-heart failure treatment indicats that CGA may support clinical parameters revealing therapeutic effect. 4.Patients with high levels of CGA have poor outcome within 60 days. |
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