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An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation
Secondary tricuspid regurgitation (sTR) is frequent among patients with heart failure with reduced ejection fraction (HFrEF), however it confers considerable diagnostic challenges. The assessment of neurohumoral activation may constitute a valuable supplement to the current imaging-based diagnostic...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712812/ https://www.ncbi.nlm.nih.gov/pubmed/33207714 http://dx.doi.org/10.3390/jpm10040233 |
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author | Spinka, Georg Bartko, Philipp E. Heitzinger, Gregor Teo, Eliza Prausmüller, Suriya Arfsten, Henrike Pavo, Noemi Winter, Max-Paul Mascherbauer, Julia Hengstenberg, Christian Hülsmann, Martin Goliasch, Georg |
author_facet | Spinka, Georg Bartko, Philipp E. Heitzinger, Gregor Teo, Eliza Prausmüller, Suriya Arfsten, Henrike Pavo, Noemi Winter, Max-Paul Mascherbauer, Julia Hengstenberg, Christian Hülsmann, Martin Goliasch, Georg |
author_sort | Spinka, Georg |
collection | PubMed |
description | Secondary tricuspid regurgitation (sTR) is frequent among patients with heart failure with reduced ejection fraction (HFrEF), however it confers considerable diagnostic challenges. The assessment of neurohumoral activation may constitute a valuable supplement to the current imaging-based diagnostic process. This study sought to investigate the expression of complementary biomarkers in sTR and to evaluate the effectiveness of integrating their assessment into the diagnostic process. We enrolled 576 HFrEF patients recording echocardiographic and biochemical measurements, i.e., N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin, C-terminal pro-endothelin-1 (CT-pro-ET1), and copeptin. Plasma levels of the aforementioned neurohormones were significantly elevated with increasing sTR severity (p < 0.001 for all). CT-pro-ET1 and MR-proANP were the closest related to severe sTR (adj. OR 1.46; 95%CI 1.11–1.91, p = 0.006 and adj. OR 1.45, 95%CI 1.13–1.87, p = 0.004, respectively). In patients with moderate-to-severe sTR, adding selected biomarkers (i.e., CT-pro-ET1 and MR-proANP) resulted in a substantial improvement in the discriminatory power regarding long-term mortality (C-statistic: 0.54 vs. 0.65, p < 0.001; continuous NRI 57%, p < 0.001). Circulating biomarkers closely relate to sTR severity and correlate with hemodynamic and morphologic mechanisms of sTR. Specifically, MR-proANP and CT-pro-ET1 are closely linked to the presence of severe sTR, and a combined assessment with the guideline recommended echocardiographic grading significantly improves individual risk stratification. |
format | Online Article Text |
id | pubmed-7712812 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-77128122020-12-04 An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation Spinka, Georg Bartko, Philipp E. Heitzinger, Gregor Teo, Eliza Prausmüller, Suriya Arfsten, Henrike Pavo, Noemi Winter, Max-Paul Mascherbauer, Julia Hengstenberg, Christian Hülsmann, Martin Goliasch, Georg J Pers Med Article Secondary tricuspid regurgitation (sTR) is frequent among patients with heart failure with reduced ejection fraction (HFrEF), however it confers considerable diagnostic challenges. The assessment of neurohumoral activation may constitute a valuable supplement to the current imaging-based diagnostic process. This study sought to investigate the expression of complementary biomarkers in sTR and to evaluate the effectiveness of integrating their assessment into the diagnostic process. We enrolled 576 HFrEF patients recording echocardiographic and biochemical measurements, i.e., N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin, C-terminal pro-endothelin-1 (CT-pro-ET1), and copeptin. Plasma levels of the aforementioned neurohormones were significantly elevated with increasing sTR severity (p < 0.001 for all). CT-pro-ET1 and MR-proANP were the closest related to severe sTR (adj. OR 1.46; 95%CI 1.11–1.91, p = 0.006 and adj. OR 1.45, 95%CI 1.13–1.87, p = 0.004, respectively). In patients with moderate-to-severe sTR, adding selected biomarkers (i.e., CT-pro-ET1 and MR-proANP) resulted in a substantial improvement in the discriminatory power regarding long-term mortality (C-statistic: 0.54 vs. 0.65, p < 0.001; continuous NRI 57%, p < 0.001). Circulating biomarkers closely relate to sTR severity and correlate with hemodynamic and morphologic mechanisms of sTR. Specifically, MR-proANP and CT-pro-ET1 are closely linked to the presence of severe sTR, and a combined assessment with the guideline recommended echocardiographic grading significantly improves individual risk stratification. MDPI 2020-11-16 /pmc/articles/PMC7712812/ /pubmed/33207714 http://dx.doi.org/10.3390/jpm10040233 Text en © 2020 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 Spinka, Georg Bartko, Philipp E. Heitzinger, Gregor Teo, Eliza Prausmüller, Suriya Arfsten, Henrike Pavo, Noemi Winter, Max-Paul Mascherbauer, Julia Hengstenberg, Christian Hülsmann, Martin Goliasch, Georg An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation |
title | An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation |
title_full | An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation |
title_fullStr | An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation |
title_full_unstemmed | An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation |
title_short | An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation |
title_sort | integrated imaging and circulating biomarker approach for secondary tricuspid regurgitation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712812/ https://www.ncbi.nlm.nih.gov/pubmed/33207714 http://dx.doi.org/10.3390/jpm10040233 |
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