Systolic Pulmonary Artery Pressure and Cardiovascular Biomarkers—New Non-Invasive Ways to Detect Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis Undergoing TAVR?

Elke Boxhammer¹, Clara Köller¹, Vera Paar¹, Dzeneta Fejzic¹, Richard Rezar¹, Christian Reiter², Jürgen Kammler^1,2, Jörg Kellermair², Matthias Hammerer¹, Hermann Blessberger², Clemens Steinwender^1,2, Uta C. Hoppe¹, Michael Lichtenauer^1,*

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¹ Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria

² Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria

^*Correspondence: m.lichtenauer@salk.at (Michael Lichtenauer)
Academic Editor: Dinesh Kalra

Rev. Cardiovasc. Med. 2022, 23(7), 224; https://doi.org/10.31083/j.rcm2307224

Submitted: 15 February 2022 | Revised: 18 March 2022 | Accepted: 25 March 2022 | Published: 24 June 2022

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Patients with severe aortic valve stenosis (AS) frequently present with pulmonary hypertension (PH). The gold standard for detection of pulmonary hypertension is right heart catheterization, which is not routinely performed as a preoperative standard in cardiology centers today, neither before surgical valve replacement nor before transcatheter aortic valve replacement (TAVR) procedure. Echocardiographic determination of systolic pulmonary artery pressure (sPAP) provides an opportunity to assess the presence or absence of PH. The aim of the present study was to investigate the extent to which plasma levels of common cardiovascular biomarkers behave in patients with severe AS and an sPAP $<$ 40 mmHg in comparison to patients with an sPAP $\geq$ 40 mmHg. Methods: 179 patients with echocardiographic evidence of severe AS before TAVR procedure were divided into 2 groups based on sPAP. An sPAP of 40 mmHg was considered the cut-off value, with absence of PH defined by an sPAP $<$ 40 mmHg (n = 82) and presence of PH defined by an sPAP $\geq$ 40 mmHg (n = 97). Directly before TAVR, a blood sample was drawn from each patient, and plasma concentrations of the cardiovascular biomarkers Soluble Suppression of Tumorigenicity-2 (sST2), Growth/Differentiation of Factor-15 (GDF-15), Heart-Type Fatty-Acid Binding Protein (H-FABP), Insulin Like Growth Factor Binding Protein 2 (IGF-BP2), Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR), Brain Natriuretic Peptide (BNP) and Cardiac Troponin I (cTnI) were determined. Results: Patients with an sPAP $\geq$ 40 mmHg had significantly higher sST2 (p = 0.010), GDF-15 (p = 0.005), IGF-BP2 (p = 0.029), suPAR (p = 0.018), BNP (p $<$ 0.001) and cTnI (p = 0.039) plasma levels. Only for H-FABP (p = 0.069), no significant differences were discernible between the two groups. In addition, cut-off values were calculated to predict an sPAP $\geq$ 40 mmHg. Significant results were shown with 16045.84 pg/mL for sST2 (p = 0.010), with 1117.54 pg/mL for GDF-15 (p = 0.005), with 107028.43 pg/mL for IGF-BP2 (p = 0.029), with 3782.84 pg/mL for suPAR (p = 0.018), with 2248.00 pg/mL for BNP (p $<$ 0.001) and with 20.50 pg/mL for cTnI (p = 0.002). Conclusions: sPAP as an echocardiographic parameter in combination with supplementary use of cardiovascular biomarkers presented here have the potential to provide more detailed information about the presence or absence of PH in a non-invasive way.

Keywords

aortic valve stenosis

biomarker

pulmonary hypertension

systolic pulmonary artery pressure

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Fig. 1.

Biomarker analysis. Serum concentrations of sST2 (A), GDF-15 (B), H-FABP (C), IGF-BP2 (D), suPAR (E) and BNP (F) in patients with an sPAP $<$ 40 mmHg and with an sPAP $\geq$ 40 mmHg.

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174