Davide Bolignano1,2, Salvatore De Rosa3,4, Marta Greco5,6, Pierangela Presta7, Gemma Patella7, Giuseppina Crugliano7, Jolanda Sabatino3,4, Antonio Strangio3, Letizia Rosa Romano3, Alessandro Comi7, Paola Cianfrone7, Michele Andreucci7,6, Francesco Dragone5, Ciro Indolfi3,4,8, Daniela Patrizia Foti5,9, Giuseppe Coppolino7,6. 1. Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy. davide.bolignano@gmail.com. 2. Department of Medical and Surgical Sciences-Renal Unit, Magna Graecia University of Catanzaro, Campus Salvatore Venuta, Viale Europa, 88100, Catanzaro, Italy. davide.bolignano@gmail.com. 3. Department of Medical and Surgical Sciences-Renal Unit, Magna Graecia University of Catanzaro, Campus Salvatore Venuta, Viale Europa, 88100, Catanzaro, Italy. 4. Cardiovascular Research Center, Magna Graecia University of Catanzaro, Catanzaro, Italy. 5. Clinical Pathology Lab, Magna Graecia University of Catanzaro, Catanzaro, Italy. 6. Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy. 7. Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy. 8. Mediterranea Cardiocentro, Naples, Italy. 9. Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Abstract
PURPOSE: Left ventricular hypertrophy (LVH) is remarkably prevalent among end-stage kidney disease (ESKD) on chronic dialysis and has a strong prognostic value for adverse outcomes. In experimental models, the endogenous cardiotonic steroid Marinobufagenin (MBG) promotes cardiac hypertrophy and accelerates uremic cardiomyopathy. In this study, we investigated the possible relationships between MBG, LV geometry and cardiac dysfunction in a clinical setting of ESKD. METHODS: Plasmatic MBG was measured in 46 prevalent ESKD patients (n = 30 HD, n = 16 PD) together with a thorough laboratory, clinical, bioimpedance and echocardiography assessment. Different patterns of LV geometry were defined by left ventricular mass index (LVMi) and ventricular morphology. Diastolic dysfunction was diagnosed by the ASE/EACVI criteria. RESULTS: MBG levels were significantly higher in ESKD patients than in healthy controls (p = 0.001) and more elevated in PD than in HD (p = 0.02). At multivariate analyses, E/e' (β = 0.38; p = 0.009) and LVMi (β = 0.42; p = 0.02) remained the sole independent predictors of MBG. A statistically significant trend in MBG levels (p = 0.01) was noticed across different patterns of LV geometry, with the highest values found in eccentric LVH. MBG levels were higher in the presence of diastolic dysfunction (p = 0.01) and this substance displayed a remarkable diagnostic capacity in distinguish patients with normal LV geometry, LV hypertrophy and, particularly, eccentric LVH (AUC 0.888; p < 0.0001) and diastolic dysfunction (AUC 0.79; p = 0.001). CONCLUSIONS: Deranged plasma MBG levels in ESKD patients on chronic dialysis reflect alterations in LV structure and function. MBG may, thus, candidate as a novel biomarker for improving cardiac assessment in this high-risk population.
PURPOSE: Left ventricular hypertrophy (LVH) is remarkably prevalent among end-stage kidney disease (ESKD) on chronic dialysis and has a strong prognostic value for adverse outcomes. In experimental models, the endogenous cardiotonic steroid Marinobufagenin (MBG) promotes cardiac hypertrophy and accelerates uremic cardiomyopathy. In this study, we investigated the possible relationships between MBG, LV geometry and cardiac dysfunction in a clinical setting of ESKD. METHODS: Plasmatic MBG was measured in 46 prevalent ESKD patients (n = 30 HD, n = 16 PD) together with a thorough laboratory, clinical, bioimpedance and echocardiography assessment. Different patterns of LV geometry were defined by left ventricular mass index (LVMi) and ventricular morphology. Diastolic dysfunction was diagnosed by the ASE/EACVI criteria. RESULTS: MBG levels were significantly higher in ESKD patients than in healthy controls (p = 0.001) and more elevated in PD than in HD (p = 0.02). At multivariate analyses, E/e' (β = 0.38; p = 0.009) and LVMi (β = 0.42; p = 0.02) remained the sole independent predictors of MBG. A statistically significant trend in MBG levels (p = 0.01) was noticed across different patterns of LV geometry, with the highest values found in eccentric LVH. MBG levels were higher in the presence of diastolic dysfunction (p = 0.01) and this substance displayed a remarkable diagnostic capacity in distinguish patients with normal LV geometry, LV hypertrophy and, particularly, eccentric LVH (AUC 0.888; p < 0.0001) and diastolic dysfunction (AUC 0.79; p = 0.001). CONCLUSIONS: Deranged plasma MBG levels in ESKD patients on chronic dialysis reflect alterations in LV structure and function. MBG may, thus, candidate as a novel biomarker for improving cardiac assessment in this high-risk population.
Authors: Natalia I Agalakova; Yulia N Grigorova; Ivan A Ershov; Vitaly A Reznik; Elena V Mikhailova; Olga V Nadei; Leticia Samuilovskaya; Larisa A Romanova; C David Adair; Irina V Romanova; Alexei Y Bagrov Journal: Int J Mol Sci Date: 2022-03-19 Impact factor: 5.923