Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

NAG provides advanced prognostic capabilities in patients suffering from DCM compared to coronary artery disease in a cohort of ICD patients, opposite to urinary NT-proBNP

R. Allgaier1, C. Strack1, S. Wallner2, U. Hubauer1, E. Ücer1, P. Lehn2, A. Keyser3, A. Luchner4, L. S. Maier1, C. G. Jungbauer1

1Klinik und Poliklinik für Innere Med. II, Kardiologie, Universitätsklinikum Regensburg, Regensburg; 2Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Regensburg, Regensburg; 3Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg; 4Klinik für Kardiologie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg;

Objectives: Chronic heart failure may lead to worsening renal function. Interdependency of cardiac and renal function is described as cardiorenal syndrome. The prognostic capabilities of both urinary biomarkers NT-proBNP and N-acetyl-ß-D-glucosaminidase (NAG) regarding all-cause mortality in a collective of ICD-patients were shown recently. Aim of the study was to assess differences between urinary NT-proBNP and NAG in patients suffering from DCM vs. patients suffering from coronary artery disease. Methods: 214 ICD patients were included in the study. NAG as well as urinary NT-proBNP were assessed from fresh spot urine and each marker was normalized to urinary creatinine. Follow-up was performed after 51 months (IQR 25-55). Outcome of interest was all-cause mortality. Results: 140 patients were suffering from coronary artery disease and 74 patients were suffering from DCM. Patients with coronary artery disease had a significantly higher rate of hypertension, average age, male sex, and secondary prevention ICD indication compared to patients suffering from DCM (each p < 0.05). There were no differences regarding ejection fraction, existence of chronic kidney disease and marker levels of urinary NT-proBNP and NAG (each p = n.s.). During follow up 48 patients deceased. ROC analysis of NAG regarding all-cause mortality showed significantly higher AUCs in patients suffering from DCM compared to coronary artery disease (DCM: AUC 0.80 vs coronary artery disease: AUC 0.59; p = 0.02), opposite to urinary NT-proBNP (DCM: AUC 0.74 vs coronary artery disease: AUC 0.75; p = n.s.). According to Kaplan-Meier analysis, NAG ≥ median was shown as significant predictor for all-cause mortality in patients suffering from DCM (p = 0.01), opposite to patients suffering from coronary artery disease (p = n.s.). Urinary NT-proBNP ≥ median was shown as significant predictor in patients suffering from DCM as well as coronary artery disease regarding all-cause mortality (p < 0.01). In Cox regression analysis, NAG was an independent predictor for all-cause mortality in patients suffering from DCM (p = 0.02), opposite to patients suffering from coronary artery disease (p = n.s.). Urinary NT-proBNP was shown as independent predictor for all-cause mortality in patients suffering from DCM as well as coronary artery disease (each p <0.04). Conclusion: Urinary NT-proBNP and NAG show different prognostic capabilities in patients with cardiorenal syndrome depending on the underlying cardiac disease. These findings attribute NAG advanced potential in patients suffering from DCM.

https://dgk.org/kongress_programme/jt2023/aP2190.html