Secretoneurin as predictive marker for mortality and progression of ejection fraction in a real-life ICD-cohort

Background: Secretoneurin is an innovative cardiac marker associated with adverse arrhythmic events and worsening heart failure. Data in regard to patients with ICD are scarce.

Aims: The goal of this study was to evaluate the predictive value of Secretoneurin in a real-life cohort of patients with ICD, taking current ejection fraction (EF) into account as well as course of EF.

Methods: 445 patients from our out-patient clinic were recruited into this prospective study. Every patient received echocardiographic examination upon study inclusion as well as at least once per year during follow up (median 8 follow up echocardiographies). Blood and urine samples were collected upon study inclusion. In dependence of the course of EF, patients were either classified as preserved (EF > 40% in every echocardiography; n=132), reduced (each EF ≤ 40%; n=74), recovered (EF initially ≤ 40%, but improved over time and stayed > 40% thereafter; n=60), undulating (EF repeatedly changing between > and ≤ 40%; n=57)  or worsened (initial EF > 40% but worsened and stayed ≤ 40%; n=13). Patients who died during follow-up were evaluated as a separate group.  

Results: Patients were predominantly men (83.4%), median age was 68 years (IQR 57-76 years). 225 patients received ICD due to secondary prevention (50.6%). Median EF was 41% upon study inclusion (IQR 33%-53%). Median levels of serum creatinine were 1.11 mg/dl (mean 0.91-1.47mg/dl). 109 Patients died during follow up (median 2 years, IQR 1-4 years).
Patients who died during follow-up showed significantly higher levels of Secretoneurin upon study inclusion compared to surviving patients, as well as to each EF group separately (each p < 0.05). Patients with preserved EF showed significantly lower levels of Secreoneurin than patients with reduced, recovered or undulating EF (each p < 0.05). In ROC-analyses Secretoneurin showed very promising AUC to predict preserved EF (AUC 0.76) as well as mortality (AUC 0.74) in the overall cohort. The predictive value in regard to mortality was especially high in patients with preserved EF (AUC 0.84). In multivariate binary logistic regression analyses, Secretoneurin was significantly associated with mortality, independent from age, sex, ICD indication, EF and Serum creatinine.  

Conclusion: In the current study, lower levels of Secretoneurin were associated with stable preserved EF. Higher levels of Seceroneurin were associated with higher mortality, especially in patients with preserved EF.