Abstract
BackgroundAdiponectin is a biomarker closely related to heart failure. However, its role in pulmonary hypertension remains unclear. In this study, we investigated the association between adiponectin and hemodynamic abnormalities, right ventricular function in patients with congenital heart disease associated pulmonary hypertension (CHD-PH).MethodsPatients with CHD-PH were enrolled in this cross-sectional study. Linear regression analysis was performed to assess the association between adiponectin, N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and different clinical parameters. Results were depicted as beta-estimates(ß) with 95%-confidence intervals (95% CI). In addition, mediation and receiver operating characteristic curve analyses were used to analyze the relationships among adiponectin, NT-proBNP and right ventricular function.ResultsA total of 86 CHD-PH patients were included. The overall mean adiponectin concentration was 7.9 ± 5.8 μg/ml. Log adiponectin was positively correlated with pulmonary circulation index (ß = 2.2, 95% CI 0.5, 4.0), log NT-proBNP (ß = 0.22, 95% CI 0.04, 0.41) and inversely with the tricuspid annular plane systolic excursion (TAPSE, ß = -4.7, 95% CI -8.6, − 0.8). The mediation analysis revealed the association between NT-proBNP and TAPSE was fully mediated by adiponectin (total effect c = − 5.4, 95% CI -9.4, − 1.5, p = 0.013; direct effect c’ = − 3.7, 95% CI -7.5, 0.1, p = 0.067). Additionally, the efficiency of adiponectin for detecting right ventricular dysfunction was not inferior to NT-proBNP (AUC = 0.84, 95% CI 0.67–1.00 vs AUC = 0.74, 95% CI 0.51–0.97, p = 0.23).ConclusionsAdiponectin is closely correlated with pulmonary blood flow and right ventricular function and may be a valuable biomarker for disease assessment in patients with pulmonary hypertension.
Highlights
Adiponectin is a biomarker closely related to heart failure
Adiponectin is closely correlated with pulmonary blood flow and right ventricular function and may be a valuable biomarker for disease assessment in patients with pulmonary hypertension
Whether plasma adiponectin correlates with hemodynamics in patients with congenital heart disease associated pulmonary hypertension (CHD-Pulmonary hypertension (PH)) or is just as a confounder accompanying with increased NTproBNP, has not been examined
Summary
Patients were included if systemic-pulmonary shunting cardiac defects were reported in their echocardiogram and required further assessment by the right heart catheterization (RHC) after evaluated by their physicians. Missing data for right ventricular function was inevitable in this study and we could only perform subgroup analysis for this part. Linear regression models were used to estimate the nonadjusted or adjusted (age, gender, BMI, creatinine, TRIG/HDLC and glucose levels) association between adiponectin, NT-proBNP and echocardiographic, hemodynamic parameters. Mediation analysis was performed to assess the potential mechanistic relationship between NT-proBNP and adiponectin on right ventricular function. Receiver operating characteristic (ROC) curve analyses were performed and the area under the curve (AUC) was calculated to evaluate the diagnostic efficiency of APN and NT-proBNP for right ventricular dysfunction.
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