Exercise MR-proANP unmasks latent right heart failure in CTEPH

Kriechbaum, Steffen; Birmes, Judith; Wiedenroth, Christoph B.; Adameit, Miriam S.D.; Grün, Dimitri; Vietheer, Julia; Richter, Manuel J.; Guth, Stefan; Roller, Fritz; Rademann, Matthias; Fischer‐Rasokat, Ulrich; Rolf, Andreas; Liebetrau, Christoph; Hamm, Christian W.; Keller, Till; Rieth, Andreas

doi:10.1016/j.healun.2022.08.017

Cited by 2 publications

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“…The ANP release pattern is highly dependent on the hemodynamic stress triggers applied to the right atrium and pulmonary circulation, mainly under exertion ( 22 , 23 ). For these reasons, the NT-proANP might represent a potential accurate biomarker related to the right atrial stress and impaired pulmonary hemodynamic.…”

Section: Discussionmentioning

confidence: 99%

“…ANP is mainly released by atrial cardiomyocytes in response to hemodynamic stressors, such as pressure and volume overload. ANP release kinetic is highly triggered by the haemodynamic load applied to the right atrium and pulmonary circulation, mainly under exercise ( 22 , 23 ). Simultaneously, the same hemodynamic triggers for ANP secretion contribute to impair the ventricular performance and arterial stiffness, promoting the RV/PA uncoupling.…”

Section: Introductionmentioning

confidence: 99%

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The prognostic role of the echocardiographic tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio and its relationship with NT-proANP plasma level in systemic sclerosis

Grimaldi

Rosato

D'Angelo

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio is an echocardiographic estimation of the right ventricle to pulmonary artery (RV/PA) coupling, with a validated prognostic role in different clinical settings. Systemic sclerosis (SSc) patients without evident cardiovascular involvement frequently display subtle RV impairment. The amino-terminal atrial natriuretic peptide (NT-proANP) plasma level relates to SSc disease progression and mortality. We aimed to assess the prognostic value of the TAPSE/sPAP ratio and its relationship with NT-proANP plasma level in SSc patients without overt cardiovascular involvement.MethodsWe retrospectively analysed 70 SSc consecutive patients, with no clinical evidence of cardiovascular involvement or pulmonary hypertension (PH), and 30 healthy controls (HC) in a retrospective, single-centre study. All SSc patients underwent recurrent clinical and echocardiographic assessments and NT-proANP plasma level was assessed at baseline. SSc-related cardiovascular events and deaths were extracted during a 6-year follow-up. The complete work-up for the diagnosis, treatment and management of PH performed along the 6 years of follow-up referred to the 2015 European Society of Cardiology guidelines.ResultsSystemic sclerosis patients showed lower TAPSE/sPAP ratio at baseline compared to HC [SSc median value = 0.71 mm/mmHg, (IQR 0.62–0.88) vs. HC median value = 1.00 mm/mmHg, (IQR 0.96–1.05); p < 0.001]. Multivariable Cox analysis revealed TAPSE/sPAP ratio as an independent predictor for SSc-related cardiovascular events [HR = 3.436 (95% CI 1.577–7.448); p = 0.002] and mortality [HR = 3.653 (95% CI 1.712–8.892); p = 0.014]. The value of TAPSE/sPAP ratio < 0.7 mm/mmHg was identified as an optimal cut-off for predicting adverse outcomes (p < 0.001) by receiver operating characteristic (ROC) analyses. NT-proANP level significantly related to TAPSE/sPAP ratio (r = 0.52, p < 0.001). TAPSE/sPAP ratio combined with NT-proANP showed an overall significant prognostic role in this SSc population, confirmed by Kaplan–Meier analysis (Log rank p < 0.001).ConclusionThe TAPSE/sPAP ratio, as an index of RV/PA coupling, is an affordable predictor of cardiovascular events and mortality in SSc and, combined with NT-proANP level, may improve the clinical phenotyping and prognostic stratification of SSc patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%