Catestatin as a predictor for cardiac death in heart failure with mildly reduced and preserved ejection fraction
Song-Yun Chu1, Fen Peng1,2, Jie Wang1
1Department of Cardiology, Peking University First Hospital, Beijing, China.
Insights
Catestatin, a peptide linked to heart failure, predicts cardiac death differently across heart failure types. Elevated catestatin is a more sensitive predictor for cardiac outcomes in patients with mildly reduced or preserved ejection fraction heart failure.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Pathophysiology
Background:
- Catestatin, an endogenous catecholamine release-inhibitory peptide, has been implicated in heart failure (HF).
- Understanding its role across different HF phenotypes is crucial for risk stratification.
- Previous studies have suggested an association between catestatin and HF, but subgroup-specific predictive value remains unclear.
Purpose of the Study:
- To investigate the differential effects of plasma catestatin as a predictor of cardiac outcomes in patients with heart failure with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF).
- To compare the predictive accuracy of catestatin for cardiac death across these HF subgroups.
Main Methods:
- A cohort of 228 heart failure patients with a spectrum of ejection fractions was analyzed.
- Plasma catestatin levels were measured.
- Cardiac deaths were analyzed in prespecified subgroups (HFrEF, HFmrEF, HFpEF) over a median follow-up of 52.5 months.
Main Results:
- The association between plasma catestatin and cardiac death varied significantly across HF subgroups (interaction P = 0.022).
- Plasma catestatin was a more potent predictor of cardiovascular death in HFmrEF/HFpEF patients (AUC = 0.72) compared to HFrEF patients (AUC = 0.59).
- An optimal catestatin level of 0.86 ng/mL predicted a 2.80-fold increased risk of cardiac death in HFmrEF/HFpEF.
Conclusions:
- Elevated plasma catestatin levels may serve as a more sensitive biomarker for predicting cardiac outcomes in patients with HFmrEF and HFpEF compared to those with HFrEF.
- These findings highlight the differential prognostic value of catestatin across the heart failure spectrum.
- Further research may elucidate the mechanisms underlying these distinct associations.
Aims:
Endogenous catecholamine release-inhibitory peptide catestatin has been associated with heart failure (HF). This subgroup analysis of our cohort of HF compared the different effects of catestatin as a predictor for cardiac outcomes in patients with HF with reduced (HFrEF), mildly reduced (HFmrEF) or preserved (HFpEF) ejection fraction.
Methods:
Plasma catestatin was measured in the HF patient cohort of 228 cases with a whole spectrum of ejection fraction. The cardiac deaths were analysed according to prespecified subgroups.
Results:
Over a median follow-up of 52.5 months, the association between plasma catestatin and cardiac death was different in patients with HFrEF, HFmrEF or HFpEF [hazard ratio (HR) 1.53, 95% confidence interval (CI) 0.99-2.37 and HR 2.73, 95% CI 1.56-4.75, respectively; interaction P = 0.022]. Patients with HFmrEF/HFpEF were older and more likely to be female, with non-ischaemic cardiomyopathy and atrial fibrillation but lower levels of plasma B-type natriuretic peptide (BNP). Similar adverse cardiac events occurred in patients with HFmrEF/HFpEF as in HFrEF. Plasma catestatin was a better predictor for cardiovascular death in the HFmrEF/HFpEF patients [area under the receiver operating characteristic curve (AUC) = 0.72, 95% CI 0.45-0.74] than in the HFrEF patients (AUC = 0.59, 95% CI 0.587-0.849). The optimal cut point of plasma catestatin level of 0.86 ng/mL predicted a 2.80-fold elevated risk for cardiac death in HFmrEF/HFpEF.
Conclusions:
Elevated plasma catestatin might be a more sensitive predictor for cardiac outcome in patients with HFmrEF/HFpEF than in HFrEF.
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