Relaxin serum levels in acute heart failure are associated with pulmonary hypertension and right heart overload

Pintalhao, Mariana; Castro-Chaves, Paulo; Vasques‐Nóvoa, Francisco; Gonçalves, Francisco Rocha; Mendonça, Luís; Fontes‐Carvalho, Ricardo; Lourenço, Patrícia; Almeida, Pedro; Leite‐Moreira, Adelino F.; Bettencourt, Paulo

doi:10.1002/ejhf.611

Cited by 23 publications

(33 citation statements)

References 32 publications

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“…Haemoglobin values are reduced in pregnant women as a result of the physiological increase in volaemia, a condition that, in part, reflects the adaptive increase in relaxin‐2 secretion. Of note, the absence of a correlation between relaxin‐2 and NT‐proBNP concentrations in the RELAHF study confirms previously published results in smaller studies . This lack of relationship may be attributable to differences in the release mechanisms and stimuli of each of these proteins …”

Section: Discussionsupporting

confidence: 88%

“…This incidence lies between the 7% described by Martinez‐Solano et al . and the 25% reported by Pintalhao et al . It is likely that differences in the baseline characteristics of the various study populations explain this variation.…”

Section: Discussionmentioning

confidence: 52%

“…Conversely, Pintalhao et al . reported a relationship between relaxin concentrations and in‐hospital mortality in 117 patients with AHF . Finally, in 115 patients with chronic HF, Xie et al .…”

Section: Discussionmentioning

confidence: 95%

“…A few studies have reported that relaxin concentrations are elevated in patients with moderate–severe dilated cardiomyopathy and are correlated with the severity of heart failure (HF), but not with mortality or rehospitalization rates or with natriuretic peptide blood concentrations. In a recent study, relaxin concentrations were found to be related to clinical and echocardiographic markers of pulmonary hypertension …”

Section: Introductionmentioning

confidence: 98%

“…In a recent study, relaxin concentrations were found to be related to clinical and echocardiographic markers of pulmonary hypertension. 7 In view of the scarcity of data, we designed the present exploratory study in patients with AHF recruited in emergency departments (EDs). The objectives were to investigate: (i) the frequencies of patients with detectable and undetectable relaxin concentrations; (ii) the clinical factors associated with undetectable relaxin concentrations and whether undetectable relaxin concentrations are associated with short-term outcome, and (iii) the clinical factors associated with relaxin concentrations in patients with detectable values and whether there is a relationship between relaxin concentrations and short-term outcome.…”

Section: Introductionmentioning

confidence: 99%

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The relationship of circulating relaxin‐2 concentrations with short‐term prognosis in patients with acute heart failure: the RELAHF study

Herrero‐Puente

Prieto

García-García

et al. 2017

European J of Heart Fail

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The relationship of circulating relaxin‐2 concentrations with short‐term prognosis in patients with acute heart failure: the RELAHF study

Herrero‐Puente

Prieto

García-García

et al. 2017

European J of Heart Fail

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Are circulating relaxin levels related to pulmonary hypertension in patients with heart failure?

Emmens

Maaten

Voors³

2017

European J of Heart Fail

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Pintalhao

Castro-Chaves

Bettencourt

2017

European J of Heart Fail

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ReplyWe read with great interest the research letter from Emmens et al. 1 and thank the authors for their comments on our recently published paper in this journal. 2 Emmens et al. evaluated relaxin circulating levels in a cohort of patients with heart failure (HF) with preserved ejection fraction (HFpEF) and pulmonary hypertension (PH) and found no association between relaxin groups and echocardiographically or invasively determined intracardiac pressures. 1 These results do not extend our recent findings that relaxin circulating levels were associated with clinical and echocardiographic markers of volume overload, PH and right heart dysfunction and overload in a population of acute HF patients. 2 Several differences between the study populations are worth noting and may help to elucidate the differences between the results of the two studies. We evaluated relaxin levels at admission in a population of patients with acute HF, including both patients with HFpEF and those with HF with reduced ejection fraction. 2 These patients were heterogeneous with respect to the degree of volume overload, volume distribution and echocardiographic parameters of chamber dimensions and function, which allowed us to establish different patterns of pulmonary pressures and right heart overload among relaxin groups. 2 In the study by Emmens et al., 1 all patients had chronic HFpEF with established PH. This patient selection criterion may, on one hand, have hindered the establishment of differences in pulmonary and right heart pressures between groups. However, on the other hand, it supports our hypothesis of increased relaxin secretion to circulation in states of PH as relaxin levels in these patients (median: 82.3 pg/mL) 1 were higher than have .been described in most previous studies addressing relaxin levels in HF, including our own. The lack of relaxin levels below the detection limit of the assay, 1 unlike in our study in which levels were undetectable in about 25% of patients, 2 also strengthens this hypothesis.In line with the promising results of serelaxin clinical trials in HF, 3,4 increasing evidence suggests a role for endogenous relaxin in HF pathophysiology. The hypothesis of a compensatory up-regulation of the relaxin system in states of PH and of a role for this system in the modulation of pulmonary vasculature is compelling based on the available evidence, 2,4,5 but further studies are needed to corroborate it. Better understanding of the role of endogenous relaxin in the pathophysiology of acute and chronic HF may be of great value in terms of expanding the therapeutic use of serelaxin in this context. References1. Emmens JE, ter Maaten JM, Voors AA. Are circulating relaxin levels related to pulmonary hypertension in patients with heart failure? Eur J Heart Fail 2017;19:958-960. 2. Pintalhao M, Castro-Chaves P, Vasques-Novoa F, Goncalves F, Mendonca L, Fontes-Carvalho R, Lourenco P, Almeida P, Leite-Moreira A, Bettencourt P. Relaxin serum levels in acute heart failure are associated with pulmonary hypertension and rig...

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Relaxin serum levels in acute heart failure are associated with pulmonary hypertension and right heart overload

Abstract: In our population of acute HF patients, admission relaxin serum levels were associated with clinical and echocardiographic markers of pulmonary hypertension, RV dysfunction, and overload, suggesting a role for circulating relaxin as a biomarker in this setting.

Cited by 23 publications

References 32 publications

The relationship of circulating relaxin‐2 concentrations with short‐term prognosis in patients with acute heart failure: the RELAHF study

The relationship of circulating relaxin‐2 concentrations with short‐term prognosis in patients with acute heart failure: the RELAHF study

Are circulating relaxin levels related to pulmonary hypertension in patients with heart failure?

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