Ilja M Blok1, Annelieke C M J van Riel1, Mark J Schuuring2, Rianne H A C M de Bruin-Bon2, Arie P J van Dijk3, Elke S Hoendermis4, Aeilko H Zwinderman2, Barbara J M Mulder1, Berto J Bouma5. 1. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; ICIN - Netherlands Heart Institute, Utrecht, The Netherlands. 2. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 3. Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands. 4. Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. 5. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: b.j.bouma@amc.nl.
Abstract
BACKGROUND: Adults with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) have a poor prognosis. Identifying patients with a high risk for clinical events and death is important because their prognosis can be improved by intensifying their treatment. Cystatin C, a novel cardiac biomarker, correlates with right ventricular dimensions in patients with idiopathic PAH, giving it potential to determine prognosis in PAH-CHD patients. We investigated the predictive value of cystatin C for long-term mortality and clinical events. METHODS: Fifty-nine PAH-CHD patients (mean age 42 SD 13 years, 42% male) were included in this prospective observational study, with cystatin C measurements between 2005 and 2015 on the outpatient clinic. Patients were evaluated with a standardized evaluation protocol including laboratory, functional and echocardiographic variables. Clinical events comprised worsening functional classification, worsening heart failure, symptomatic hyperviscosity, haemoptysis and arrhythmia. We used Cox regression to determine predictors for mortality and clinical events. RESULTS: Mean follow-up was 4.4years, during which 12 (20%) patients died. Cystatin C (HR 1.3, p<0.001), creatinine (HR 1.2, p<0.001), NT-pro-BNP (HR 2.0, p=0.012), hs-troponin T (HR 1.9, p=0.005), 6-MWD (HR 0.8, p=0.044) and TAPSE (HR 0.8, p<0.001) predicted mortality. Similar results were found for the prediction of clinical events. When adjusted for NT-pro-BNP or glomerular filtration rate in multivariate analysis, cystatin C remained predictive for mortality. CONCLUSIONS: Cystatin C, a novel cardiac biomarker, predicts long-term mortality and clinical events in patients with PAH-CHD. Consequently, cystatin C may attribute to clinical decision making regarding treatment intensity.
BACKGROUND: Adults with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) have a poor prognosis. Identifying patients with a high risk for clinical events and death is important because their prognosis can be improved by intensifying their treatment. Cystatin C, a novel cardiac biomarker, correlates with right ventricular dimensions in patients with idiopathic PAH, giving it potential to determine prognosis in PAH-CHDpatients. We investigated the predictive value of cystatin C for long-term mortality and clinical events. METHODS: Fifty-nine PAH-CHDpatients (mean age 42 SD 13 years, 42% male) were included in this prospective observational study, with cystatin C measurements between 2005 and 2015 on the outpatient clinic. Patients were evaluated with a standardized evaluation protocol including laboratory, functional and echocardiographic variables. Clinical events comprised worsening functional classification, worsening heart failure, symptomatic hyperviscosity, haemoptysis and arrhythmia. We used Cox regression to determine predictors for mortality and clinical events. RESULTS: Mean follow-up was 4.4years, during which 12 (20%) patients died. Cystatin C (HR 1.3, p<0.001), creatinine (HR 1.2, p<0.001), NT-pro-BNP (HR 2.0, p=0.012), hs-troponin T (HR 1.9, p=0.005), 6-MWD (HR 0.8, p=0.044) and TAPSE (HR 0.8, p<0.001) predicted mortality. Similar results were found for the prediction of clinical events. When adjusted for NT-pro-BNP or glomerular filtration rate in multivariate analysis, cystatin C remained predictive for mortality. CONCLUSIONS:Cystatin C, a novel cardiac biomarker, predicts long-term mortality and clinical events in patients with PAH-CHD. Consequently, cystatin C may attribute to clinical decision making regarding treatment intensity.
Authors: Yang Zi-Yang; Zhao Kaixun; Luo Dongling; Yin Zhou; Zhou Chengbin; Chen Jimei; Zhang Caojin Journal: J Int Med Res Date: 2020-11 Impact factor: 1.671
Authors: Jason Hong; Douglas Arneson; Soban Umar; Gregoire Ruffenach; Christine M Cunningham; In Sook Ahn; Graciel Diamante; May Bhetraratana; John F Park; Emma Said; Caroline Huynh; Trixie Le; Lejla Medzikovic; Marc Humbert; Florent Soubrier; David Montani; Barbara Girerd; David-Alexandre Trégouët; Richard Channick; Rajan Saggar; Mansoureh Eghbali; Xia Yang Journal: Am J Respir Crit Care Med Date: 2021-04-15 Impact factor: 21.405