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Prognostic Usefulness of Proenkephalin in Stable Ambulatory Patients With Heart Failure
Boris Arbit1, Nick Marston1, Kevin Shah1
1Division of Cardiovascular Medicine, Department of Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, California.
Insights
Proenkephalin (proENK) is a novel biomarker that predicts cardiovascular events in stable patients. Higher proENK levels indicate increased risk for hospital admission or death in heart failure patients.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Heart failure (HF) patients have a poor prognosis, necessitating early risk identification.
- Proenkephalin (proENK) is a novel biomarker and predictor of HF and death post-myocardial infarction.
Purpose of the Study:
- To evaluate the prognostic utility of proENK in stable ambulatory heart failure patients.
- To assess the association between proENK levels and cardiovascular outcomes.
Main Methods:
- A 4-year prospective cohort study of 200 outpatients referred for echocardiography.
- Blood samples analyzed for proENK levels at baseline.
- Patients monitored for cardiovascular-related hospital admission or death.
Main Results:
- Higher proENK levels correlated with older age, poorer renal function, lower ejection fraction, and comorbidities like hypertension and diabetes.
- The highest proENK tertile showed a 3.0-fold increased risk (HR 3.0) for the primary endpoint compared to the lowest tertile.
- Proenkephalin levels demonstrated significant prognostic value.
Conclusions:
- Proenkephalin (proENK) is a valuable prognostic biomarker in stable ambulatory heart failure patients.
- Elevated proENK levels predict cardiovascular-related hospital admission or death.
- This study highlights proENK's utility beyond acute cardiac events.
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.
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