Abstract
BackgroundWe studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146 (sCD146), in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success.MethodsBiomarkers were tested in 40 patients the day before and the day after PMC. Success was defined as mitral valve area ≥ 1.5 cm2; or an increase of ≥0.5 cm2 in mitral valve area associated with echocardiographic mitral regurgitation <grade 3–4 post-PMC.ResultsAverage age was 63.5 ± 12.7 years; 32(80%) were female. Before PMC, mean valve area was 1.1 ± 0.2 cm2, mean gradient 9.1 ± 3.5 mmHg. PMC was successful in 30 (75%) and unsuccessful in 10 (25%). PMC yielded a significant reduction in MR-proANP and sCD146, driven by a significant reduction in these biomarkers in patients with successful procedure, whereas no reduction was observed in patients with unsuccessful procedure. A significant correlation was found between changes in plasma sCD146 and the relative change in mitral valve area. Elevated pre-procedural sPAP correlated with high sCD146, and accordingly, a significant correlation between the decrease in sPAP and sCD146 after PMC was shown.ConclusionsMR-proANP and plasma sCD146 decreased significantly immediately after successful PMC. They appear to be markers of immediate success of PMC and of the hemodynamic improvement achieved by this procedure in patients with MS.Trial registrationThis study is part of the cohorts registered with ClinicalTrials.gov on June 16, 2011 under the number NCT01374880.
Highlights
We studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146, in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success
The soluble form of CD146 - an adhesion molecule expressed by vascular endothelial cells and implicated in vessel integrity - is released by the endothelium [9] and circulating soluble endothelial CD146 (sCD146) levels are related to pulmonary congestion in heart failure [10, 11]
Our study describes the behaviour of cardiovascular biomarkers before and after PMC in patients with severe
Summary
We studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146 (sCD146), in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success. The use of natriuretic peptides has become widespread in cardiology, with brain natriuretic peptide (BNP) and Nterminal pro-B-type natriuretic peptide (NT-proBNP) used daily as markers of heart failure [1,2,3]. These two biomarkers remain imperfect for the diagnosis of pulmonary and systemic congestion [4,5,6]. Combining BNP/NT-proBNP with other biomarkers could help to improve their diagnostic value In this regard, other natriuretic peptides such as mid-regional pro-atrial natriuretic peptide (MR-proANP) are emerging as biomarkers that are more strongly associated with venous congestion of cardiac origin [7, 8]. Some authors have shown that sCD146 is released from the peripheral veins in response to stretch [12], but the involvement of the heart cavities, notably the left ventricle, and pulmonary circulation in the release of sCD146 during congestion is unknown
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