α-1 Antitrypsin as a potential biomarker in chronic heart failure.

Background: Heart failure is characterized by a tissue damage that progressively leads to mechanical cardiac dysfunction and remodeling. A recent investigation showed that α-1 antitripsin, an antiprotease, able to inhibit metalloproteinases, provides prognostic information about heart failure and mortality postacute myocardial infarction. Therefore, we conducted a study to establish if α-1 antitrypsin (AAT) could be considered a marker of severity of heart failure.

Methods: A total of 182 heart failure patients (Group 1) were enrolled and AAT values were compared with controls (Group 2).

Results: In Group 1 a significant increment of AAT levels respect to Group 2 was observed (P < 0.0001). Moreover, in patients enrolled a progressive elevation of AAT levels across New York Heart Association classes (P < 0.0001) was found. Patients with α-1 antitripsin levels above median value showed lower hemoglobin concentration, higher circulating levels of C-reactive protein, hs-troponin T and B-type natriuretic peptide prohormone. Group 1 AAT levels resulted highly positively associated to B-type natriuretic peptide prohormone, C-reactive protein levels, while negatively associated to left ventricular ejection fraction%. However, at multivariate logistic analysis, only C-reactive protein was confirmed in a subgroup of postischemic heart failure patients.

Conclusion: Adding AAT levels to the panel of heart failure biomarkers allow a better stratification of patients with heart failure.