Abstract
The study aimed to identify early echocardiographic and circulating biomarkers of heart failure (HF) in hypertensive patients with normal resting echocardiography. Echocardiography at rest and during exercise, and selected biomarkers were assessed in control group, dyspnea group, and HF group. On exercise dyspnea patients had lower early diastolic (E') and systolic (S') mitral annular velocity (12.8 ± 1.0 vs 14.9 ± 3.0 cm/sec and 9.3 ± 2.0 vs 10.9 ± 2.0 cm/sec, respectively), and higher E/E' ratio compared to control group (6.7 ± 1.0 vs 5.9 ± 1.0) (p < 0.05 for all comparisons). The level of N-terminal propeptide of procollagen type III (PIIINP) was significantly higher in dyspnea group than in controls (p = 0.01). Control and dyspnea patients had lower levels of cardiotrophin-1, cystatin C, syndecan-4, and N terminal–probrain natriuretic peptide than HF patients (all p ≤ 0.01). In multivariate analysis PIIINP (unadjusted odds ratio [OR] = 8.2, 95% confidence interval [Cl] 1.7–40.6; p = 0.001; adjusted OR = 8.7; 95%CI: 1.5–48.3; p = 0.001) and E/E' ratio on exercise (unadjusted OR = 1.8, 95%CI: 0.8–4.0; p = 0.033; adjusted OR = 2.0; 95%CI: 0.8–4.8; p = 0.012) were the only factors significantly associated with the presence of dyspnea. PIIINP is the first early biomarker for the HF development in patients with HA and normal resting echocardiography. Exertional echocardiography may indicate patients with incipient HF with preserved ejection fraction.
Highlights
The study aimed to identify early echocardiographic and circulating biomarkers of heart failure (HF) in hypertensive patients with normal resting echocardiography
The reason for the enormous burden of hypertension has been reported in numerous studies, showing that hypertensive disease is strongly associated with overall CV risk1/Increased blood pressure (BP) contributes to both CV and cerebrovascular endpoints, including heart failure (HF), myocardial infarction (MI), and stroke[1]
The remaining 99 hypertensive patients were grouped into 3 groups: 22 asymptomatic hypertensive patients, 27 patients with exertional dyspnea and 50 hypertensive patients with overt HF
Summary
The study aimed to identify early echocardiographic and circulating biomarkers of heart failure (HF) in hypertensive patients with normal resting echocardiography. There are several biomarkers from different biological pathways reflecting the multi-systemic character of HF, which should be considered based on the analysis of the available literature[8,9,10,11,12]: N terminal-probrain natriuretic peptide (NT-proBNP) - biomarker of myocyte stress and gold standard for HF; cardiotrophin-1 (CT-1) - a member of the interleukin-6 (IL-6) family of cytokines; tumour necrosis factor-alpha (TNF-alpha) a proinflammatory cytokine, IL-1 receptor like protein 1 (IL1R1) - a receptor for proinflammatory cytokine IL-1; cystatin C (CysC) -a low-molecular weight protein from the group of cysteine proteinase inhibitors; transforming growth factor-beta 1 (TGF-beta 1) - a central regulator of cardiac fibrosis; N-terminal propeptide of procollagen type III (PIIINP) - one of the biomarkers of extracellular matrix remodeling; galectin-3 - a protein involved in cell adhesion, cell activation, chemoattraction, cell growth, cell differentiation, fibroblast activation and apoptosis; syndecan-4 - a biomarker of left ventricular remodeling; neutrophil gelatinase-associated lipocalin (lipocalin-2/NGAL) - a glycoprotein involved in cell survival, inflammation and matrix degradation[8,9,10,11,12]. The study was designed to try establish the panel of diagnostic tests in patients with hypertension, which will allow for early detection of abnormalities and to clarify the etiology of exertional dyspnea in patients with hypertension and normal resting echocardiography
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