Assessment of successful percutaneous mitral commissurotomy by MRproANP and sCD146

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 cm 2 ; 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 cm 2 , 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.

Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC)

“…In acute HF patients, the greater the degree of mitral regurgitation, the greater the level of sCD146 176 . Furthermore, in patients with mitral stenosis, sCD146 is markedly elevated and drops within few hours of mitral angioplasty, although natriuretic peptides remained unchanged 177 . This might imply sCD146 may be a biomarker of congestion, released by a stretched venous endothelium.…”

“… 176 Furthermore, in patients with mitral stenosis, sCD146 is markedly elevated and drops within few hours of mitral angioplasty, although natriuretic peptides remained unchanged. 177 This might imply sCD146 may be a biomarker of congestion, released by a stretched venous endothelium. However, far more data are needed before this assertion may be confirmed.…”

Natriuretic peptides as predictors for atrial fibrillation recurrence after catheter ablation: A meta-analysis

“…MR-proANP is a stable peptide that results from the cleavage of proANP (pro-ANP) [ 30 ] and proANP is stored and released by atrial cardiomyocytes and is cleaved into mature ANP and its N-terminal fragment, NT-proANP. [ 31 ] Within this fragment is the midregional section, MR-proANP, which has a longer half-life than mature ANP, making its assessment more reliable.…”

“…[ 32 ] It was previously shown that MR-proANP is elevated in numerous pathologies specifically affecting the left atrium, such as mitral stenosis. [ 30 , 33 ] Meanwhile, MR-proANP is increased in patients with AF, independently of hemodynamic conditions, and also that there is a link between AF burden and MR-proANP levels. [ 34 ] Other studies have also reported that CA for AF significantly reduced plasma concentrations of ANP and MR-proANP in the long term.…”

“…Baseline NT-proBNP levels were higher in patients with recurrence than in those who remained arrhythmia-free, but the association was rendered non-significant when adjusted for variables. [29] MR-proANP is a stable peptide that results from the cleavage of proANP (pro-ANP) [30] and proANP is stored and released by atrial cardiomyocytes and is cleaved into mature ANP and its N-terminal fragment, NT-proANP. [31] Within this fragment is the midregional section, MR-proANP, which has a longer half-life than mature ANP, making its assessment more reliable.…”