Cysteine-rich angiogenic inducer 61 (CCN1) independently predicts all-cause mortality in patients with dilated cardiomyopathy

Abstract Introduction Cysteine-rich angiogenic inducer 61 (Cyr61, CCN1) is a member of the CCN family of matricellular proteins exerting key functions in inflammation and fibrotic turnover. Recently it has been shown that CCN1 improves risk stratification for all-cause mortality in ACS patients. Purpose Since both inflammation and fibrosis are key processes involved in the pathogenesis of dilated cardiomyopathy (DCM), we aimed to investigate the prognostic value of CCN1 serum levels for survival in a large cohort of DCM patients. Methods The cohort compromised patients with a primary diagnosis of DCM, defined as a reduced left ventricular ejection fraction (LVEF <45%) and an increased left ventricular enddiastolic diameter according to the HENRY score (LVEDD according to HENRY >117%) at the time of diagnosis. Exclusion criteria were primary valvular diseases (≥ second degree), acute myocarditis, active infectious diseases, pulmonary diseases, cancer, chronic alcoholism and heart failure of other origins. CCN1 levels were determined in human serum using an enzyme-linked immunosorbent assay (R&D Systems, USA). Multivariable cox regression models for the association between CCN1 and all-cause mortality were adjusted for age, sex, disease duration, LVEF, estimated glomerular filtration rate (eGFR) measured based on the CKD-EPI formula, high-sensitivity C-reactive protein (hs-CRP) and aminoterminal-proB-type natriuretic peptide (NT-proBNP) levels. Results 306 DCM patients had available biomarker and clinico-demographic data in this single-center cohort (79.3% males) with a mean age of 55.2 years [interquartile range [IQR] 47.9, 64.8]). On average, disease duration was 0.3 years (IQR 0.9, 1.9), LVEF 31% (IQR 25, 37), LVEDD 67.7 mm (IQR 63, 72), and eGFR 91.5 ml/min (IQR 74.1, 102.4). During a median follow-up of 12.5 years (IQR 10.5, 14.1), a total of 114 (37.3%) patients died. Multivariable-adjusted cox regression models revealed an increasing all-cause mortality risk across CCN1 tertiles (p for trend = 0.03), with the highest incidence in the highest tertile (hazard ratio [HR] 1.75; 95%-CI 1.04, 2.94; P=0.034) as compared to the lowest tertile (Figure 1). Conclusion CCN1 predicts long-term survival in DCM patients independent of NT-pro-BNP and other risk determinants. Further research needs to evaluate whether this novel biomarker also plays a causal role in the pathogenesis of DCM. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Kerckhoff Foundation Figure 1