ABSTRACT
Background:
Patients with severe
aortic valve stenosis (AS) frequently present with
pulmonary hypertension (
PH). The
gold standard for
detection of
pulmonary hypertension is right
heart catheterization, which is not routinely performed as a preoperative standard in
cardiology centers today, neither before
surgical valve replacement nor before
transcatheter aortic valve replacement (TAVR)
procedure. Echocardiographic
determination of systolic
pulmonary artery pressure (sPAP) provides an opportunity to assess the presence or absence of
PH. The aim of the present study was to investigate the extent to which
plasma levels of common cardiovascular
biomarkers behave in
patients with severe AS and an sPAP < 40 mmHg in comparison to
patients with an sPAP ≥ 40 mmHg.
Methods:
179
patients with echocardiographic evidence of severe AS before TAVR
procedure were divided into 2 groups based on sPAP. An sPAP of 40 mmHg was considered the cut-off value, with absence of
PH defined by an sPAP < 40 mmHg (n = 82) and presence of
PH defined by an sPAP ≥ 40 mmHg (n = 97). Directly before TAVR, a
blood sample was drawn from each
patient, and
plasma concentrations of the cardiovascular
biomarkers Soluble
Suppression of Tumorigenicity-2 (sST2),
Growth/Differentiation of Factor-15 (
GDF-15),
Heart-Type Fatty-
Acid Binding Protein (
H-FABP),
Insulin Like Growth Factor Binding Protein 2 (IGF-BP2), Soluble
Urokinase-Type Plasminogen Activator Receptor (suPAR),
Brain Natriuretic Peptide (BNP) and Cardiac
Troponin I (cTnI) were determined.
Results:
Patients with an sPAP ≥ 40 mmHg had significantly higher sST2 (p = 0.010),
GDF-15 (p = 0.005), IGF-BP2 (p = 0.029), suPAR (p = 0.018), BNP (p < 0.001) and cTnI (p = 0.039)
plasma levels. Only for
H-FABP (p = 0.069), no significant differences were discernible between the two groups. In addition, cut-off values were calculated to predict an sPAP ≥ 40 mmHg. Significant results were shown with 16045.84 pg/mL for sST2 (p = 0.010), with 1117.54 pg/mL for
GDF-15 (p = 0.005), with 107028.43 pg/mL for IGF-BP2 (p = 0.029), with 3782.84 pg/mL for suPAR (p = 0.018), with 2248.00 pg/mL for BNP (p < 0.001) and with 20.50 pg/mL for cTnI (p = 0.002).
Conclusions:
sPAP as an echocardiographic parameter in combination with supplementary use of cardiovascular
biomarkers presented here have the potential to provide more detailed information about the presence or absence of
PH in a non-invasive way.