The levels of neuropeptide Y (NPY) in the coronary sinus may be associated with outcomes in individuals with stable coronary heart failure (CHF) who are undergoing cardiac resynchronization therapy, according to an article recently published in JAMA Cardiology.

In this single-center prospective observational cohort study, 105 patients with stable CHF and treated with cardiac resynchronization therapy were enrolled. Blood from the coronary sinus was collected during resynchronization device implantation procedure. The study’s primary outcome was a composite of hospitalization for CHF and major adverse cardiovascular events (MACE). The mean NPY level in the coronary sinus was 85.1±31 pg/mL. The NPY level was found to be associated with decreased estimated glomerular filtration rate (Spearman correlation coefficient, rs=-0.36; P =.0002) and increased serum creatinine (rs=0.22; P =.023) and blood urea nitrogen (rs=0.30; P =.0018) levels, but not with age, functional status, CRT response, or left ventricular ejection fraction. In participants with coronary sinus NPY ≥130 pg/mL, the hazard ratio (HR) for MACE-free survival was 9.5 (95% CI, 2.92-30.5; P <.001), and 8.9 (95% CI, 3.1-25.7; P <.001) in patients with NPY <130 pg/mL. Patients with vs without CHF had lower NPY immunoreactivity, particularly in the stellate ganglia containing the soma of postganglionic efferent neurons that innervate the heart, but comparable expression of the molecule.

Study limitations include a lack of assessment of cardiac or systemic NPY release, and a small sample size.

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“[Coronary sinus] NPY levels are elevated, associated with adverse outcomes, and are significantly associated with clinical and laboratory characteristics in patients [with] stable CHF,” concluded the investigators. “Increased stellate ganglia neuronal release is likely responsible for the elevated levels. These data suggest that [coronary sinus] NPY levels may provide prognostic information in patients with CHF.”

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Ajijola OA, Chatterjee NA, Gonzales MJ, et al. Coronary sinus neuropeptide Y levels and adverse outcomes in patients with stable chronic heart failure [published online December 26, 2019]. JAMA Cardiol. doi: 10.1001/jamacardio.2019.4717