Abstract
MicroRNA (miR)-210 expression is induced by acute and chronic hypoxia and provides prognostic information in patients with aortic stenosis and acute coronary syndrome. We hypothesized that circulating miR-210 concentrations could provide diagnostic and prognostic information in patients with acute heart failure (HF). We measured miR-210 concentrations in serum samples on admission from 314 patients hospitalized for acute dyspnea and 9 healthy control subjects. The diagnostic and prognostic properties of miR-210 were tested in patients after adjudication of all diagnoses and with median follow-up of 464 days. All patients and control subjects had miR-210 concentrations within the range of detection, and the analytical variation was low as the coefficient of variation of synthetic spike-in RNA was 4%. Circulating miR-210 concentrations were increased in patients with HF compared to healthy control subjects, but miR-210 concentrations did not separate patients with acute HF (n = 143) from patients with non-HF-related dyspnea (n = 171): the area under the curve was 0.50 (95% CI 0.43-0.57). Circulating miR-210 concentrations were associated with mortality (n = 114) after adjustment for clinical risk factors (hazard ratio 1.65 [95% CI 1.03-2.62] per unit miR-210 increase), but this association was attenuated and not significant after adjustment for established cardiac protein biomarkers. Circulating miR-210 concentrations are associated with mortality, but do not add to established protein biomarkers for diagnosis or prognosis in patients with acute dyspnea.
Highlights
Dyspnea is a common symptom in patients admitted to hospital emergency departments and is associated with high probability of serious illness [1]
We assessed 468 patients presenting with acute dyspnea at the Emergency Department of Akershus University Hospital and included 314 patients into the study (Fig. 1)
143 (46% of total) had heart failure (HF) as the adjudicated cause of admission, while 84 (27% of total) within the remaining 171 patients were adjudicated as acute exacerbation of chronic obstructive pulmonary disease (AECOPD)
Summary
Dyspnea is a common symptom in patients admitted to hospital emergency departments and is associated with high probability of serious illness [1]. Acute heart failure (HF) is a prevalent condition in patients with dyspnea, and measurement of cardiac protein biomarkers has been found to improve diagnostic accuracy for acute HF and to risk stratify patients with dyspnea [2]. Many miRs are found in peripheral blood samples, and a number of specific miRs have been shown to have potential as biomarkers for cardiovascular disease. MiR-210 is a principal hypoxamir [6] and circulating miR-210 concentrations provide prognostic information in patients with coronary artery disease and aortic stenosis [7, 8]. MicroRNA (miR)-210 expression is induced by acute and chronic hypoxia and provides prognostic information in patients with aortic stenosis and acute coronary syndrome. We hypothesized that circulating miR-210 concentrations could provide diagnostic and prognostic information in patients with acute heart failure (HF)
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