Assessment of successful percutaneous mitral commissurotomy by MRproANP and sCD146

Marc Badoz, Mattia Arrigo, Anne-Claire Mogenet, Malha Sadoune, Nicolas Meneveau, Alexandre Mebazaa, Marie-France Seronde, Marc Badoz, Mattia Arrigo, Anne-Claire Mogenet, Malha Sadoune, Nicolas Meneveau, Alexandre Mebazaa, Marie-France Seronde

Abstract

Background: We studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146 (sCD146), in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success.

Methods: Biomarkers were tested in 40 patients the day before and the day after PMC. Success was defined as mitral valve area ≥ 1.5 cm2; or an increase of ≥0.5 cm2 in mitral valve area associated with echocardiographic mitral regurgitation <grade 3-4 post-PMC.

Results: Average age was 63.5 ± 12.7 years; 32(80%) were female. Before PMC, mean valve area was 1.1 ± 0.2 cm2, mean gradient 9.1 ± 3.5 mmHg. PMC was successful in 30 (75%) and unsuccessful in 10 (25%). PMC yielded a significant reduction in MR-proANP and sCD146, driven by a significant reduction in these biomarkers in patients with successful procedure, whereas no reduction was observed in patients with unsuccessful procedure. A significant correlation was found between changes in plasma sCD146 and the relative change in mitral valve area. Elevated pre-procedural sPAP correlated with high sCD146, and accordingly, a significant correlation between the decrease in sPAP and sCD146 after PMC was shown.

Conclusions: MR-proANP and plasma sCD146 decreased significantly immediately after successful PMC. They appear to be markers of immediate success of PMC and of the hemodynamic improvement achieved by this procedure in patients with MS.

Trial registration: This study is part of the cohorts registered with ClinicalTrials.gov on June 16, 2011 under the number NCT01374880.

Keywords: Biomarker; Brain natriuretic peptide; MRproANP; Mitral stenosis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Individual data for the plasma cardiovascular biomarkers under study, before (pre) and after (post) percutaneous mitral commissurotomy for each patient (top panels) and overall (bottom panels)
Fig. 2
Fig. 2
Correlation between relative change in sCD146 and relative change in mitral valve area
Fig. 3
Fig. 3
Correlation between sPAP pre-PMC and sCD146 pre-PMC
Fig. 4
Fig. 4
Correlation between reduction in sPAP and reduction in sCD146. Negative values mean increase of sCD146 or sPAP between pre and post-PMC

References

    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the heart failure association (HFA) of the ESC. Eur J Heart Fail. 2016;2016(18):891–975. doi: 10.1002/ejhf.592.
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013;2013(62):e147–e239. doi: 10.1016/j.jacc.2013.05.019.
    1. Troughton R, Michael Felker G, Januzzi JL., Jr Natriuretic peptide-guided heart failure management. Eur Heart J. 2014;35:16–24. doi: 10.1093/eurheartj/eht463.
    1. Harada E, Mizuno Y, Kugimiya F, Shono M, Maeda H, Yano N, Kuwahara K, Yasue H. B-type natriuretic peptide in heart failure with preserved ejection fraction- relevance to age-related left ventricular modeling in Japanese. Circ J. 2017;81:1006–1013. doi: 10.1253/circj.CJ-16-1282.
    1. Khalid U, Wruck LM, Quibrera PM, Bozkurt B, Nambi V, Virani SS, Jneid H, Agarwal S, Chang PP, Loehr L, et al. BNP and obesity in acute decompensated heart failure with preserved vs. reduced ejection fraction: the atherosclerosis risk in communities surveillance study. Int J Cardiol. 2017;233:61–66. doi: 10.1016/j.ijcard.2017.01.130.
    1. Meijers WC, Hoekstra T, Jaarsma T, van Veldhuisen DJ, de Boer RA. Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides. Neth Heart J. 2016;24:287–295. doi: 10.1007/s12471-016-0816-8.
    1. Van Aelst LNL, Arrigo M, Placido R, Akiyama E, Girerd N, Zannad F, Manivet P, Rossignol P, Badoz M, Sadoune M, et al. Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion. Eur J Heart Fail. 2018;20:738–747. doi: 10.1002/ejhf.1050.
    1. Wohrle J, Karakas M, Trepte U, Seeger J, Gonska B, Koenig W, Rottbauer W. Midregional-proAtrial natriuretic peptide and high sensitive troponin T strongly predict adverse outcome in patients undergoing percutaneous repair of mitral valve regurgitation. PLoS One. 2015;10:e0137464. doi: 10.1371/journal.pone.0137464.
    1. Boneberg EM, Illges H, Legler DF, Furstenberger G. Soluble CD146 is generated by ectodomain shedding of membrane CD146 in a calcium-induced, matrix metalloprotease-dependent process. Microvasc Res. 2009;78:325–331. doi: 10.1016/j.mvr.2009.06.012.
    1. Gayat E, Caillard A, Laribi S, Mueller C, Sadoune M, Seronde MF, Maisel A, Bartunek J, Vanderheyden M, Desutter J, et al. Soluble CD146, a new endothelial biomarker of acutely decompensated heart failure. Int J Cardiol. 2015;199:241–247. doi: 10.1016/j.ijcard.2015.07.039.
    1. Kubena P, Arrigo M, Parenica J, Gayat E, Sadoune M, Ganovska E, Pavlusova M, Littnerova S, Spinar J, Mebazaa A. Plasma levels of soluble CD146 reflect the severity of pulmonary congestion better than brain natriuretic peptide in acute coronary syndrome. Ann Lab Med. 2016;36:300–305. doi: 10.3343/alm.2016.36.4.300.
    1. Arrigo M, Truong QA, Onat D, Szymonifka J, Gayat E, Tolppanen H, Sadoune M, Demmer RT, Wong KY, Launay JM, et al. Soluble CD146 is a novel marker of systemic congestion in heart failure patients: an experimental mechanistic and Transcardiac clinical study. Clin Chem. 2017;63:386–393. doi: 10.1373/clinchem.2016.260471.
    1. Wilkins GT, Weyman AE, Abascal VM, Block PC, Palacios IF. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br Heart J. 1988;60:299–308. doi: 10.1136/hrt.60.4.299.
    1. Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP., Jr Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987;75:175–183. doi: 10.1161/01.CIR.75.1.175.
    1. Frea S, Capriolo M, Marra WG, Cannillo M, Fusaro E, Libertucci D, Morello M, Gaita F. Echo Doppler predictors of pulmonary artery hypertension in patients with systemic sclerosis. Echocardiography. 2011;28:860–869. doi: 10.1111/j.1540-8175.2011.01467.x.
    1. Tuzcu EM, Block PC, Griffin BP, Newell JB, Palacios IF. Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older. Circulation. 1992;85:963–971. doi: 10.1161/01.CIR.85.3.963.
    1. Fatkin D, Roy P, Morgan JJ, Feneley MP. Percutaneous balloon mitral valvotomy with the Inoue single-balloon catheter: commissural morphology as a determinant of outcome. J Am Coll Cardiol. 1993;21:390–397. doi: 10.1016/0735-1097(93)90680-Y.
    1. Reid CL, McKay CR, Chandraratna PA, Kawanishi DT, Rahimtoola SH. Mechanisms of increase in mitral valve area and influence of anatomic features in double-balloon, catheter balloon valvuloplasty in adults with rheumatic mitral stenosis: a Doppler and two-dimensional echocardiographic study. Circulation. 1987;76:628–636. doi: 10.1161/01.CIR.76.3.628.
    1. Morgenthaler NG, Struck J, Thomas B, Bergmann A. Immunoluminometric assay for the midregion of pro-atrial natriuretic peptide in human plasma. Clin Chem. 2004;50:234–236. doi: 10.1373/clinchem.2003.021204.
    1. Ala-Kopsala M, Magga J, Peuhkurinen K, Leipala J, Ruskoaho H, Leppaluoto J, Vuolteenaho O. Molecular heterogeneity has a major impact on the measurement of circulating N-terminal fragments of A- and B-type natriuretic peptides. Clin Chem. 2004;50:1576–1588. doi: 10.1373/clinchem.2004.032490.
    1. Seidler T, Pemberton C, Yandle T, Espiner E, Nicholls G, Richards M. The amino terminal regions of proBNP and proANP oligomerise through leucine zipper-like coiled-coil motifs. Biochem Biophys Res Commun. 1999;255:495–501. doi: 10.1006/bbrc.1999.0225.
    1. Nakamura M, Kawata Y, Yoshida H, Arakawa N, Koeda T, Ichikawa T, Funakoshi T, Hiramori K. Relationship between plasma atrial and brain natriuretic peptide concentration and hemodynamic parameters during percutaneous transvenous mitral valvulotomy in patients with mitral stenosis. Am Heart J. 1992;124:1283–1288. doi: 10.1016/0002-8703(92)90413-P.
    1. Badoz M, Arrigo M, Iung B, Amioglu G, Yilmaz MB, Meneveau N, Sadoune M, Brunette A, Mebazaa A, Seronde MF. Role of cardiovascular biomarkers for the assessment of mitral stenosis and its complications. Eur J Intern Med. 2016;34:58–62. doi: 10.1016/j.ejim.2016.05.008.
    1. Esteves WA, Lodi-Junqueira L, Neto CP, Tan TC, Nascimento BR, Mehrotra P, Barbosa MM, Ribeiro AL, Nunes MC. The impact of right ventricular stroke work on B-type natriuretic peptide levels in patients with mitral stenosis undergoing percutaneous mitral valvuloplasty. J Interv Cardiol. 2013;26:501–508.
    1. Pourafkari L, Seyedhosseini S, Kazemi B, Esmaili H, Aslanabadi N. Changes in serum NT-pro BNP and left atrial BNP levels after percutaneous Transvenous mitral Commissurotomy in sinus rhythm versus atrial Firilation. J Cardiovasc Thorac Res. 2014;6:175–179. doi: 10.15171/jcvtr.2014.007.
    1. Ramakrishnan S, Agarwal A, Singh S, Karthikeyan G, Seth S, Narang R, Bhargava B. NT-pro-BNP levels as a marker of success of percutaneous transvenous mitral commissurotomy. Indian Heart J. 2010;62:35–38.

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