Cargando…

Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis

Background: Severe aortic stenosis (AS) complicated by pulmonary hypertension (PH) is associated with poor outcomes after surgical aortic valve replacement (AVR). There is still scarce information about predictors of secondary PH in this group of patients. Objectives: The aim of this study was to in...

Descripción completa

Detalles Bibliográficos
Autores principales: Gumauskienė, Birutė, Krivickienė, Aušra, Jonkaitienė, Regina, Vaškelytė, Jolanta Justina, Siudikas, Adakrius, Ereminienė, Eglė
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174337/
https://www.ncbi.nlm.nih.gov/pubmed/30344294
http://dx.doi.org/10.3390/medicina54040063
_version_ 1783361278828347392
author Gumauskienė, Birutė
Krivickienė, Aušra
Jonkaitienė, Regina
Vaškelytė, Jolanta Justina
Siudikas, Adakrius
Ereminienė, Eglė
author_facet Gumauskienė, Birutė
Krivickienė, Aušra
Jonkaitienė, Regina
Vaškelytė, Jolanta Justina
Siudikas, Adakrius
Ereminienė, Eglė
author_sort Gumauskienė, Birutė
collection PubMed
description Background: Severe aortic stenosis (AS) complicated by pulmonary hypertension (PH) is associated with poor outcomes after surgical aortic valve replacement (AVR). There is still scarce information about predictors of secondary PH in this group of patients. Objectives: The aim of this study was to investigate the prognostic impact of biomarkers together with conventional Doppler echocardiographic parameters of left ventricular diastolic function on elevated pulmonary systolic pressure (PSP) in severe AS patients before surgical AVR. Methods: Sixty patients with severe isolated AS (aortic valve area <1 cm(2)) underwent echocardiography, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor-15 (GDF-15) measurements before AVR. PSP, left ventricular ejection fraction (LV EF), parameters of LV diastolic function (E/E’ ratio, mitral valve deceleration time (MV DT) and left atrial (LA) volume) were evaluated. PH was defined as an estimated PSP ≥ 45 mmHg. Results: Of the 60 patients, 21.7% with severe isolated AS had PH with PSP ≥ 45 mmHg (58.5 ± 11.2 mmHg). LV EF did not differ between groups and was not related to an elevated PSP (50 ± 8 vs. 49 ± 8%, p = 0.58). Parameters of LV diastolic dysfunction (E/E’ ratio > 14 (OR 6.00; 95% CI, 1.41–25.48; p = 0.009), MV DT ≤ 177.5 ms (OR 9.31; 95% CI, 2.06–41.14; p = 0.001), LA volume > 100 mL (OR 9.70; 95% CI, 1.92–49.03; p = 0.002)) and biomarkers (NT-proBNP > 4060 ng/L (OR 12.54; 95% CI, 2.80–55.99; p < 0.001) and GDF-15 > 3393 pg/mL (OR 18.33; 95% CI, 2.39–140.39; p = 0.001)) were significantly associated with elevated PSP in severe AS. Conclusions: Left ventricular diastolic dysfunction and elevated biomarkers levels could predict the development of pulmonary hypertension in patients with severe aortic stenosis. Elevation of biomarkers paired with worsening of LV diastolic dysfunction could help to stratify patients for earlier surgical treatment before the development of pulmonary hypertension.
format Online
Article
Text
id pubmed-6174337
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-61743372018-10-18 Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis Gumauskienė, Birutė Krivickienė, Aušra Jonkaitienė, Regina Vaškelytė, Jolanta Justina Siudikas, Adakrius Ereminienė, Eglė Medicina (Kaunas) Article Background: Severe aortic stenosis (AS) complicated by pulmonary hypertension (PH) is associated with poor outcomes after surgical aortic valve replacement (AVR). There is still scarce information about predictors of secondary PH in this group of patients. Objectives: The aim of this study was to investigate the prognostic impact of biomarkers together with conventional Doppler echocardiographic parameters of left ventricular diastolic function on elevated pulmonary systolic pressure (PSP) in severe AS patients before surgical AVR. Methods: Sixty patients with severe isolated AS (aortic valve area <1 cm(2)) underwent echocardiography, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor-15 (GDF-15) measurements before AVR. PSP, left ventricular ejection fraction (LV EF), parameters of LV diastolic function (E/E’ ratio, mitral valve deceleration time (MV DT) and left atrial (LA) volume) were evaluated. PH was defined as an estimated PSP ≥ 45 mmHg. Results: Of the 60 patients, 21.7% with severe isolated AS had PH with PSP ≥ 45 mmHg (58.5 ± 11.2 mmHg). LV EF did not differ between groups and was not related to an elevated PSP (50 ± 8 vs. 49 ± 8%, p = 0.58). Parameters of LV diastolic dysfunction (E/E’ ratio > 14 (OR 6.00; 95% CI, 1.41–25.48; p = 0.009), MV DT ≤ 177.5 ms (OR 9.31; 95% CI, 2.06–41.14; p = 0.001), LA volume > 100 mL (OR 9.70; 95% CI, 1.92–49.03; p = 0.002)) and biomarkers (NT-proBNP > 4060 ng/L (OR 12.54; 95% CI, 2.80–55.99; p < 0.001) and GDF-15 > 3393 pg/mL (OR 18.33; 95% CI, 2.39–140.39; p = 0.001)) were significantly associated with elevated PSP in severe AS. Conclusions: Left ventricular diastolic dysfunction and elevated biomarkers levels could predict the development of pulmonary hypertension in patients with severe aortic stenosis. Elevation of biomarkers paired with worsening of LV diastolic dysfunction could help to stratify patients for earlier surgical treatment before the development of pulmonary hypertension. MDPI 2018-09-04 /pmc/articles/PMC6174337/ /pubmed/30344294 http://dx.doi.org/10.3390/medicina54040063 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gumauskienė, Birutė
Krivickienė, Aušra
Jonkaitienė, Regina
Vaškelytė, Jolanta Justina
Siudikas, Adakrius
Ereminienė, Eglė
Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
title Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
title_full Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
title_fullStr Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
title_full_unstemmed Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
title_short Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
title_sort impact of left ventricular diastolic dysfunction and biomarkers on pulmonary hypertension in patients with severe aortic stenosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174337/
https://www.ncbi.nlm.nih.gov/pubmed/30344294
http://dx.doi.org/10.3390/medicina54040063
work_keys_str_mv AT gumauskienebirute impactofleftventriculardiastolicdysfunctionandbiomarkersonpulmonaryhypertensioninpatientswithsevereaorticstenosis
AT krivickieneausra impactofleftventriculardiastolicdysfunctionandbiomarkersonpulmonaryhypertensioninpatientswithsevereaorticstenosis
AT jonkaitieneregina impactofleftventriculardiastolicdysfunctionandbiomarkersonpulmonaryhypertensioninpatientswithsevereaorticstenosis
AT vaskelytejolantajustina impactofleftventriculardiastolicdysfunctionandbiomarkersonpulmonaryhypertensioninpatientswithsevereaorticstenosis
AT siudikasadakrius impactofleftventriculardiastolicdysfunctionandbiomarkersonpulmonaryhypertensioninpatientswithsevereaorticstenosis
AT ereminieneegle impactofleftventriculardiastolicdysfunctionandbiomarkersonpulmonaryhypertensioninpatientswithsevereaorticstenosis