Placental growth factor may predict increased left ventricular mass index in patients with mild to moderate chronic kidney disease – a prospective observational study

Abstract

BackgroundPlacental growth factor [PlGF) is a cardiovascular (CV) risk marker, which is related to left ventricle hypertrophy (LVH) in animal models. Currently there are no data available regarding the possible relationship of PlGF and the development of LVH or diastolic dysfunction in patients with chronic kidney disease (CKD) and the relationship of PlGF to other CV risk factors in CKD patients. The aim of our study was to determine the possible association of PlGF and several other CV risk markers to echocardiographic parameters in CKD population.MethodsWe prospectively examined selected laboratory (PlGF, fibroblast growth factor-23 -FGF23, vitamin D, parathyroid hormone, extracellular newly identified RAGE-binding protein - EN-RAGE, B-type natriuretic peptide - BNP) and echocardiographic parameters in 62 patients with CKD 2–4. Mean follow-up was 36 ±10 months. Laboratory and echocardiographic data were collected 2–3 times, at the shortest interval of 12 months apart. Multivariate regression analysis was used to detect independent correlations of variables.ResultsIncreased left ventricular mass index (LVMI, g/m2.7) was found in 29% patients with CKD 2–4, left ventricular (LV) diastolic dysfunction was detected in 74.1% patients (impaired LV relaxation in 43.5% patients and pseudonormal pattern in 30.6% patients). After 36 ± 10 months increased LVMI was found in 37.1% patients with CKD 2–4, LV diastolic dysfunction was detected in 75.8% patients (impaired LV relaxation in 43.5% patients and pseudonormal pattern in 32.3% patients). Following independent correlations were found: LVMI was related to PlGF, cholesterol, BNP, systolic blood pressure and serum creatinine. EN-RAGE correlated positively with left atrial diameter and inversely with E/A ratio. During the follow-up we found a significant increase in LVMI and left atrial diameter, whereas a significant decrease in LVEF was noted.ConclusionAccording to our data, PlGF is independently related to increased LV mass in CKD, whereas EN-RAGE is more likely related to diastolic dysfunction in this population.

Prognostic Impact of Placental Growth Factor on Mortality and Cardiovascular Events in Dialysis Patients

“…Of note, echocardiographic findings were similar in the high and low PlGF groups. One clinical study has shown that PlGF is strongly associated with elevated LVMI in patients with stage 2-4 CKD [26], whereas we found no significant relationship between PlGF and LVMI in dialysis patients. Additionally, patients with above-median PlGF levels had similar left ventricular systolic and diastolic function as those with below-median PlGF levels.…”

Sflt-1 in heart failure: relation with disease severity and biomarkers

“…As the levels were similar in HF patients with dilated and ischemic cardiomyopathies, the increase of sFlt-1 is not only related to ischemic conditions or coronary artery diseases and several factors could be considered. A role of vascular endothelial growth factor, which can trigger sFlt-1, in angiotensin II-induced vascular inflammation and remodeling, was also suggested [21]. Despite a lack of significant correlation with aldosterone in T2DM patients, we observed a significant relation between sFlt-1 and Gal-3, a known mediator of the fibrotic effect of aldosterone [22].…”

Placental Growth Factor as a Predictor of Cardiovascular Events in Patients with CKD from the NARA-CKD Study

“…The use of PlGF alone and BNP alone had similar diagnostic accuracy for prediction of cardiovascular events, and the combination use of PlGF and BNP had higher diagnostic accuracy than either biomarker alone. A recent study has shown that PlGF is a strong predictor of an elevated left ventricular mass index in patents with CKD, 36 suggesting that PlGF may be involved in the development of cardiac hypertrophy.…”