High Serum Level of Pregnancy Associated Plasma Protein A (PAPP-A) is a Risk Factor of Patients With Heart Failure

Abstract

Background: PAPP-A has insulin-like growth factor (IGF) binding protein-4 protease activity,which is associated with IGF bioactivity and involved in cardiac development and LV remodeling. It has been reported that PAPP-A correlates with various pathophysiologies; progression of atherosclerosis and coronary artery disease. However the clinical significance of serum PAPP-A in CHF has not been examined. The aim of this study was to determine the clinical significance of PAPP-A in patients with CHF. Methods and Results: Serum PAPP-A levels were measured in 182 patients and 20 control subjects. Serum PAPP-A levels were higher in patients with CHF than in control subjects and increased with advancing NYHA class. There were 53 cardiac events during a mean follow-up period of 796±698 days. Serum PAPP-A levels were higher in patients with cardiac events than in event-free patients.The multivariate Cox proportional hazard analysis demonstrated that serum PAPP-A levels were the independent predictor of cardiac events (hazard ratio 1.676,95% CI 1.233-2.277, p<0.001).Patients were divided into 4 groups on the basis of PAPP-A level. The highest fourth quartile of serum PAPP-A levels were associated with the highest risk of cardiac events (5.63 fold compared with the first quartile). Conclusion: Serum PAPP-A level was related to the severity of CHF and associated with a high risk for adverse cardiac events.