[The sympathetic nervous system activity estimated on serum concentration of chromogranin A in patients with the chronic heart failure].

BACKGROUND

The sympathetic nervous system is markedly activated in patients with chronic heart disease. This activation can be evaluated by assessing the serum levels of chromogranin A (CgA), the protein which is present in the all neuroendocrine cells. The main human source of CgA are adrenal medullary and sympathetic nerve endings. The aim of the study was to demonstrate if serum concentration of chromogranin A correlated to severity of chronic heart failure and it can be usefulness for clinical diagnosis.

MATERIAL AND METHODS

The serum levels of CgA were measured in 123 patients. Patients with chronic heart disease (n = 100) were divided into four groups depending of the severity of heart failure--NYHA classification (B1--NYHA I, B2--NYHA II, B3--NYHA III, B4--NYHA IV). The control group consisted of 23 persons without heart disease. The patients in both groups were examined and had performed tests: electrocardiography, echocardiography, blood morphology and the blood concentrations of creatinine, glucose, electrolytes, lipids. The serum concentration of chromogranin A was assessed by specific and immunoenzymatic sandwich ELISA test.

RESULTS

The mean serum concentration of CgA in the control group was 48.43 +/- 2.97 micrograms/L. In the chronic heart disease group the concentrations of CoA increased with the degree of NYHA heart failure and in four groups (B1, B2, B3, B4) the CgA levels were: 42.10 +/- 19.52; 49.84 +/- 22.63; 73.64 +/- 34.08; 106.66 +/- 87.54 micrograms/L respectively. The concentrations in groups B3 and B4 were significantly higher than in control group. The LV ejection fraction was reduced in groups B1-B4 (mean +/- SD): 60.12 +/- 9.20; 47.45 +/- 11.10; 40.28 +/- 9.52%. The CgA concentration was significantly negatively correlated with LV ejection fraction (r = -28). The left atrium was in group B1-B4:--32.94 +/- 4.35, 38.73 +/- 7.87, 42.57 +/- 7.98, 46.32 +/- 10.67 mm. The heart rate rised with the NYHA class (the control group (mean +/- SD): 72.96 +/- 9.15/min) and in the groups B1-B4 (mean +/- SD): 78.15 +/- 14.35, 79.90 +/- 14.67; 85.40 +/- 14.11; 93.74 +/- 16.29/min. The heart rate was significantly higher in B3 and B4 groups.

CONCLUSIONS

1. The serum concentrations of chromogranin A were correlated with the severity of chronic heart failure based on NYHA classification. 2. The CgA concentrations were significantly negatively correlated with the LV ejection fraction. 3. The chromogranin A can be used as a marker of the sympathetic nervous system activation in the patients with chronic heart failure.