Phenotyping progression of secondary mitral regurgitation in chronic systolic heart failure.
Adrenomedullin
/ blood
Aged
Atrial Natriuretic Factor
/ blood
Biomarkers
Chronic Disease
Disease Progression
Echocardiography
Endothelin-1
/ blood
Female
Glycopeptides
/ blood
Heart Failure, Systolic
/ blood
Humans
Male
Middle Aged
Mitral Valve Insufficiency
/ blood
Natriuretic Peptide, Brain
/ blood
Peptide Fragments
/ blood
Phenotype
Prognosis
Protein Precursors
/ blood
Risk Assessment
Stroke Volume
HFrEF
neurohumoral marker
sMR
sMR progression
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
19
03
2019
revised:
17
07
2019
accepted:
26
07
2019
pubmed:
30
7
2019
medline:
10
6
2020
entrez:
30
7
2019
Statut:
ppublish
Résumé
Secondary mitral regurgitation (sMR) drives adverse cardiac remodelling in patients with heart failure with reduced ejection fraction (HFrEF). Progression in severity over time contributes to a transition towards more advanced HF stages. Early identification of patients at risk for sMR progression remains challenging. We therefore sought to assess a broad spectrum of neurohumoral biomarkers in patients with HFrEF to explore their ability to predict progression of sMR. A total of 249 HFrEF patients were enrolled. Biomarkers encompassing key neurohumoral pathways in heart failure were sampled at baseline, and sMR progression was assessed over 3 years of follow-up. Of 191 patients with nonsevere sMR at baseline, 18% showed progressive sMR within three years after study enrolment. Progression of sMR was associated with higher levels of MR-proADM (adj.OR 2.25, 95% CI 1.29-3.93; P = .004), MR-proANP (adj.OR 1.84, 95% CI 1.14-3.00; P = .012), copeptin (adj.OR 1.66, 95% CI 1.04-2.67; P = .035) and CT-pro-ET1 (adj.OR 1.68, 95% CI 1.06-2.68; P = .027) but not with NT-proBNP (P = .54). Increased plasma levels of neurohumoral cardiac biomarkers are predictors of sMR progression in patients with HFrEF and add easily available incremental prognostic information for risk stratification. Importantly, NT-proBNP was not useful to predict progressive sMR in the present analysis. On the contrary, MR-proANP, primarily produced in the atria, copeptin partly triggered by intra-cardiac and intra-arterial pressures and MR-proADM, a marker of forward failure and peripheral released vasoactive CT-proET1, increase based on a progressive loading burden by sMR and may thus serve as better predictors of sMR progression.
Sections du résumé
BACKGROUND
BACKGROUND
Secondary mitral regurgitation (sMR) drives adverse cardiac remodelling in patients with heart failure with reduced ejection fraction (HFrEF). Progression in severity over time contributes to a transition towards more advanced HF stages. Early identification of patients at risk for sMR progression remains challenging. We therefore sought to assess a broad spectrum of neurohumoral biomarkers in patients with HFrEF to explore their ability to predict progression of sMR.
METHODS
METHODS
A total of 249 HFrEF patients were enrolled. Biomarkers encompassing key neurohumoral pathways in heart failure were sampled at baseline, and sMR progression was assessed over 3 years of follow-up.
RESULTS
RESULTS
Of 191 patients with nonsevere sMR at baseline, 18% showed progressive sMR within three years after study enrolment. Progression of sMR was associated with higher levels of MR-proADM (adj.OR 2.25, 95% CI 1.29-3.93; P = .004), MR-proANP (adj.OR 1.84, 95% CI 1.14-3.00; P = .012), copeptin (adj.OR 1.66, 95% CI 1.04-2.67; P = .035) and CT-pro-ET1 (adj.OR 1.68, 95% CI 1.06-2.68; P = .027) but not with NT-proBNP (P = .54).
CONCLUSION
CONCLUSIONS
Increased plasma levels of neurohumoral cardiac biomarkers are predictors of sMR progression in patients with HFrEF and add easily available incremental prognostic information for risk stratification. Importantly, NT-proBNP was not useful to predict progressive sMR in the present analysis. On the contrary, MR-proANP, primarily produced in the atria, copeptin partly triggered by intra-cardiac and intra-arterial pressures and MR-proADM, a marker of forward failure and peripheral released vasoactive CT-proET1, increase based on a progressive loading burden by sMR and may thus serve as better predictors of sMR progression.
Identifiants
pubmed: 31356682
doi: 10.1111/eci.13159
pmc: PMC6899776
doi:
Substances chimiques
Biomarkers
0
C-terminal proendothelin-1
0
Endothelin-1
0
Glycopeptides
0
Peptide Fragments
0
Protein Precursors
0
copeptins
0
mid-regional pro-adrenomedullin, human
0
midregional pro-atrial natriuretic peptide, human
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Adrenomedullin
148498-78-6
Atrial Natriuretic Factor
85637-73-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13159Informations de copyright
© 2019 Stichting European Society for Clinical Investigation Journal Foundation.
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