Prognostic Value and Kinetics of Soluble Neprilysin in Acute Heart Failure: A Pilot Study.

Abstract

OBJECTIVES:

This study sought to examine the prognostic value of the soluble form of neprilysin (sNEP) in acute heart failure (AHF) and sNEP kinetics during hospital admission.

BACKGROUND:

sNEP was recently identified in chronic heart failure (HF) and was associated with cardiovascular outcomes.

METHODS:

A total of 350 patients (53% women, mean 72.6 ± 10.7 years of age) were included in the study. Primary endpoints were composites of cardiovascular death or HF hospitalizations at short-term (2 months) and long-term (mean: 1.8 ± 1.2 years) follow-up. sNEP was measured using an ad hoc-modified enzyme-linked immunosorbent assay, and its prognostic value was assessed using Cox regression analyses. In a subgroup of patients, sNEP was measured both at admission and at discharge (n = 92).

RESULTS:

Median admission sNEP concentrations were 0.67 ng/ml (Q1 to Q3: 0.37 to 1.29), and sNEP was significantly associated, in age-adjusted Cox regression analyses, with the composite endpoint at short-term (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.04 to 1.61; p = 0.02) and long-term (HR: 1.23; 95% CI: 1.01 to 1.05; p = 0.003) follow-up. In multivariate Cox analyses that included clinical variables and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration, sNEP concentration at admission showed a clear trend toward significance for the composite endpoint at 2 months (HR: 1.22; 95% CI: 0.97 to 1.53; p = 0.09) and remained significant at the end of follow-up (HR: 1.21; 95% CI: 1.04 to 1.40; p = 0.01). At discharge, sNEP levels decreased from 0.70 to 0.52 ng/ml (p = 0.06).

CONCLUSIONS:

Admission sNEP concentration was associated with short- and long-term outcomes in AHF, and dynamic sNEP concentrations were observed during hospital admission. These preliminary data may be hypothesis-generating for the use of NEP inhibitors in AHF.

• Authors: Antoni Bayés-Genís, Jaume Barallat, Domingo Pascual-Figal, Domingo Pascual, Julio Nuñez, Gema Miñana, Jesús Sánchez-Mas, Amparo Galan, Juan Sanchis, Elisabet Zamora, María Teresa Pérez-Martínez, Josep Lupón
• Journal: JACC. Heart failure (JACC Heart Fail) Vol. 3 Issue 8 Pg. 641-4 (Aug 2015) ISSN: 2213-1787 [Electronic] United States
• PMID: 26251092 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Neprilysin

Topics

• Biomarkers (blood)
• Female
• Heart Failure (blood, diagnosis, drug therapy)
• Humans
• Male
• Neprilysin (blood)
• Pilot Projects
• Prognosis
• Reference Values