Circulating secretoneurin concentrations in patients with moderate to severe aortic stenosis

• Published in: Clinical biochemistry 2019-09, Vol.71, p.17-23
• Main Authors: Brynildsen, Jon, Myhre, Peder L., Lyngbakken, Magnus N., Klaeboe, Lars Gunnar, Stridsberg, Mats, Christensen, Geir, Edvardsen, Thor, Omland, Torbjørn, Røsjø, Helge
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve Stenosis - blood; Aortic Valve Stenosis - physiopathology; Biomarkers; Biomarkers - blood; Cardiac surgery; Case-Control Studies; Cohort Studies; Echocardiography; Electrocardiography; Female; Humans; Male; Neuropeptides - blood; Secretogranin II - blood; Secretoneurin; Severity of Illness Index
• ISSN: 0009-9120; 1873-2933; 1873-2933
• DOI: 10.1016/j.clinbiochem.2019.06.008

Secretoneurin (SN) concentrations provide important prognostic information in patients with myocardial dysfunction. Whether preoperative SN concentrations improve risk assessment in patients with moderate to severe aortic stenosis (AS) is unknown. We included 57 patients with moderate to severe AS referred for presurgical evaluation. All patients were examined with comprehensive echocardiography, electrocardiogram (ECG), and biochemical measurements and compared to 10 age- and sex-matched healthy subjects. Median (quartile 1–3) SN concentrations were 141 (121–163) pmol/L in AS patients and 132 (106–148) pmol/L in control subjects (p = .17). Lower estimated creatinine clearance and use of diuretics, but not standard ECG or echocardiographic indices and cardiac biomarkers, were associated with increasing SN concentrations. Fifteen patients (26%) died during 3.5 years median follow-up. SN concentrations were higher in non-survivors than survivors: 156 (133–209) vs. 140 (116–155) pmol/L, p = .007. Higher SN concentrations were associated with increased risk of mortality also after adjustment for established risk indices, biomarkers, and status regarding valvular surgery: hazard ratio per lnSN 15.13 (95% CI 1.05–219.00); p = .046. Receiver operating characteristics area under the curve for SN to predict mortality was 0.74 (95% CI 0.60–0.88) compared to 0.73 (0.59–0.87) for high-sensitivity cardiac troponin T and 0.67 (0.51–0.82) for N-terminal pro-B-type natriuretic peptide. The previously identified cut-off of SN >204 pmol/L in cardiac surgical patients predicted mortality also in this cohort. SN concentrations improve risk assessment in patients with moderate to severe AS by providing additional prognostic information to established risk indices such as echocardiography, ECG, and established cardiac biomarkers. •Secretoneurin (SN) concentrations separated aortic stenosis (AS) patients with a poor and favorable prognosis•SN concentrations were not correlated with established risk indices or biomarkers•SN concentrations provided additional prognostic information to established risk indices and biomarkers in patients with AS