Chromogranin A (CgA) and N Terminal –proBNP (NT-proBNP) in Evaluation and Differentiation of Systolic and Diastolic Ischemic Heart Failure: Severity Related Study

Background: The aim of this study was designed to examine the diagnostic values of biochemical markers including chromogranin A (CgA) and N terminal-proBNP (NT-proBNP) in patients with systolic and diastolic ischemic heart failure. Subjects and Methods: This cross-sectional case-control study was conducted at Clinical Chemistry Unit, Biochemistry Department, College of Medicine, University of Baghdad, and at Baghdad Teaching Hospital, Medical City, Baghdad, Iraq, during the period from October 2008 to July 2009. Fifty-five patients with ischemic heart failure (IHF) and 18 healthy individual controls were included in this study. Patients were found to be of two groups according to their etiology of IHF; Group I (GI): This group included 35 patients aged 50-75 years with Systolic Ischemic Heart Failure (SIHF inpatients), Group II (GII) consisted of 20 patients aged 44-67 years with Diastolic Ischemic Heart Failure (DIHF) who had preserved Left Ventricular function. Investigations included serum measurement of CgA and NT-proBNP concentrations by ELISA technique. Results: The mean (±SD) value of serum CgA was significantly higher in patients with systolic ischemic heart failure (SIHF) than in diastolic ischemic heart failure (P=0.001) and healthy controls (P=0.0005). There was no significant difference in serum CgA between DIHF patients and controls. The mean value of serum NT-proBNP in SIHF patients was significantly higher than those obtained for DIHF patients and controls (p=0.005, p=0.0005, respectively). In addition, serum mean value of NT-proBNP of DIHF patients was significantly elevated compared with healthy controls (p=0.023). Moreover, serum levels of CgA in severe SIHF patients (P=0.0005) and moderate SIHF (P=0.0039) were significantly higher than in mild SIHF patients. Conclusion: CgA and NT-proPNB are good biochemical markers in diagnosis of SIHF patients, including those with severe and moderate dysfunction. Serum NT-proBNP is the better biochemical marker for diagnosis of ischemic patients with diastolic dysfunction.