Chromogranin A and C-terminal endothelin-1 precursor fragment add independent prognostic information to amino-terminal proBNP in patients with acute destabilized heart failure

Clin Chim Acta. 2009 Feb;400(1-2):91-6. doi: 10.1016/j.cca.2008.10.012. Epub 2008 Oct 29.


Background: The aim of this study was to evaluate the prognostic value of chromogranin A (CgA) and C-terminal endothelin-1 precursor fragment (CT-proET-1) in patients with acute destabilized heart failure.

Methods: 137 consecutive patients with acute destabilized heart failure attending the emergency department of a tertiary care hospital were prospectively enrolled. Plasma concentrations of CgA, CT-proET-1, and amino-terminal proBNP (NT-proBNP) were measured at baseline. The endpoint was defined as all-cause mortality; the study participants were followed up for 365 days.

Results: Decedents (n=41) had higher median plasma concentrations of CgA (9.7 vs. 6.0 nmol/L; p=0.002), CT-proET-1 (120 vs. 72 pmol/L; p=0.006), and NT-proBNP (5112 vs. 2610 ng/L; p<0.001) at baseline than survivors (n=96). Applying Cox proportional-hazards regression analyses, increased CgA (>6.6 nmol/L), CT-proET-1 (>79 pmol/L), and NT-proBNP (>3275 ng/L) revealed significant risk ratios of 1.96 (95% CI, 1.04-3.70) for CgA, 2.56 (95% CI, 1.33-4.95) for CT-proET-1, and 2.05 (95% CI, 1.09-3.87) for NT-proBNP. When the cohort was stratified according to median CgA and NT-proBNP concentrations, and to median CT-proET-1 and NT-proBNP concentrations, respectively, Cox proportional-hazards regression analyses showed the highest risk for death in patients with both increased CgA and NT-proBNP (risk ratio, 3.65; 95% CI, 1.44-9.28), and increased CT-proET-1 and NT-proBNP (risk ratio, 4.03; 95% CI, 1.61-8.88).

Conclusions: Our study demonstrates that increased CgA and CT-proET-1 plasma concentrations at the initial presentation of patients with acute destabilized heart failure in the emergency department add independent prognostic information in addition to NT-proBNP measurement.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Chromogranin A / blood*
  • Data Collection
  • Endothelin-1 / chemistry*
  • Female
  • Heart Failure / blood*
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Humans
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Protein Precursors / chemistry*
  • Survival Rate


  • Biomarkers
  • Chromogranin A
  • Endothelin-1
  • Peptide Fragments
  • Protein Precursors
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain