Soluble Urokinase Plasminogen Activator Receptor Is Associated With Subclinical Myocardial Impairment by Speckle Tracking Echocardiography in Lung Cancer Patients

Abstract

BackgroundPlasma cardiac biomarkers have emerged as a cost-effective diagnostic tool aimed at early identification of cardiotoxicity. Soluble urokinase plasminogen activator receptor (suPAR) is a bone marrow cell derived signaling molecule that is associated with cardiovascular disease outcomes.ObjectivesWe investigated associations between suPAR and global longitudinal strain (GLS) as a marker of early myocardial impairment in lung cancer patients.MethodsWe retrospectively analyzed 52 patients with stage IV non-small cell lung cancer with normal left ventricular ejection fraction (LVEF >55%) and without known heart disease or end-stage renal disease (ESRD). We studied associations between cardiac biomarkers and echocardiographic measures of systolic and diastolic function. GLS was analyzed using 2D speckle-tracking echocardiography via vendor-independent software (TomTec).ResultsMedian plasma suPAR was 7.0 ng/mL (interquartile range: 5.4–9.0). Mean LVEF was 61.9 ± 8.3% and mean GLS was-19.3 ± 2.1%. Inter-observer reproducibility was excellent for GLS as determined by Intraclass Correlation Coefficient analysis, ICC = 0.81 (0.68–0.89). After multivariate analysis, suPAR was the only biomarker associated with GLS (p = 0.009). suPAR was also associated with diastolic parameters E velocity (p = 0.018), A velocity (p = 0.017), and E/E' ratio (p = 0.033). Interestingly, suPAR was not associated with LVEF (p = 0.916). In addition, suPAR and GLS were found to be age-independent predictors of all-cause mortality, though only GLS remained significant after multivariate adjustment.ConclusionsIn this cohort of stage IV non-small cell lung cancer patients with normal LVEF and without known heart disease or ESRD, suPAR was associated with GLS and diastolic impairment. suPAR is a readily available inexpensive biomarker; further research is required to evaluate the possible role of suPAR in screening for subclinical LV dysfunction in the high-risk oncological population.

Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Is a Biomarker Associated with Left Ventricular Hypertrophy in the Elderly, Specifically in Women

“…In conclusion, the authors indicated that suPAR levels were associated with diastolic dysfunction independently on age, sex, systolic blood pressure, renal function, CRP and diuretic treatment. Another study concerned patients with lung cancer who underwent a detailed echocardiographic examination to assess early cardiac dysfunction with regard to suPAR measurements in its identification [54]. It has been shown that suPAR levels correlated significantly with E/E', but not with E/A, which confirms our results.…”

“…It has been shown that suPAR levels correlated significantly with E/E', but not with E/A, which confirms our results. An additional observation was the lack of relationship between suPAR level and LVEF, as in our own and other authors' studies, where patients with generally preserved LVEF were analyzed [50,53,54]. A significant but weak negative correlation was found earlier in the population, which also included patients with reduced LVEF [49].…”

“…A significant but weak negative correlation was found earlier in the population, which also included patients with reduced LVEF [49]. In the already cited studies, an association was also found in relation to the LV systolic function in individuals with normal LVEF with S' and global longitudinal strain (GLS) parameters [53,54].…”