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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Coronary sinus biomarker sampling compared to peripheral venous blood for predicting outcomes in patients with severe
Quynh A Truong1, James L Januzzi2, Jackie Szymonifka3
1Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Coronary sinus (CS) biomarker levels, not peripheral venous (PV) levels, effectively predict cardiac resynchronization therapy (CRT) response and major adverse cardiovascular events (MACE) in heart failure patients.
Area of Science:
- Cardiology
- Biomarker Research
- Heart Failure Management
Background:
- A significant portion of patients undergoing cardiac resynchronization therapy (CRT) do not respond to the treatment.
- Identifying predictors of CRT response is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate whether coronary sinus (CS) or peripheral venous (PV) levels of heart failure (HF) biomarkers can predict CRT outcomes.
- To compare the predictive value of CS versus PV sampling for CRT success.
Main Methods:
- Seventy-three patients undergoing CRT implantation had simultaneous CS and PV blood samples collected.
- Levels of amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) were measured.
- CRT response was assessed using the HF Clinical Composite Score, and major adverse cardiovascular events (MACE) were tracked for 2 years.
Main Results:
- Coronary sinus NT-proBNP levels were higher than peripheral levels, while gal-3 and sST2 were higher in the periphery.
- Forty-five percent of patients were CRT nonresponders at 6 months, and 22% experienced MACE within 2 years.
- Triple-positive CS biomarker levels showed 95% specificity for predicting CRT nonresponse and were associated with an >11-fold increased risk of MACE, whereas PV strategies were not predictive.
Conclusions:
- Coronary sinus sampling of HF biomarkers appears superior to peripheral venous sampling for predicting CRT outcomes.
- Further research with larger cohorts is warranted to validate these findings and their clinical utility.
Background:
A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain nonresponsive to this intervention.
Objective:
This study aimed to determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes.
Methods:
In 73 patients (aged 68 ± 12 years; 83% men; ejection fraction 27% ± 7%) with CS and PV blood samples drawn simultaneously at the time of CRT device implantation, we measured amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) levels. NT-proBNP concentrations >2000 pg/mL, gal-3 concentrations >25.9 ng/mL, and sST2 concentrations >35 ng/mL were considered positive on the basis of established PV cut points for identifying "high-risk" individuals with HF. CRT response was adjudicated by the HF Clinical Composite Score. A major adverse cardiovascular event (MACE) was defined as the composite end point of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years.
Results:
NT-proBNP concentrations were 20% higher in the CS than in the periphery, while gal-3 and sST2 concentrations were 10% higher in the periphery than in the CS (all P < .001). There were 45% CRT nonresponders at 6 months and 16 (22%) patients with MACE. Triple-positive CS values yielded the highest specificity of 95% for predicting CRT nonresponse. Consistently, CS strategies identified patients at higher risk of developing MACE, with >11-fold adjusted increase for triple-positive CS patients compared to triple-negative patients (all P ≤ .04). PV strategies were not predictive of MACE.
Conclusion:
Our findings suggest that CS sampling of HF biomarkers may be better than PV sampling for predicting CRT outcomes. Larger studies are needed to confirm our findings.
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