1
|
Zhao T, Chen G, Zhu S, Zhao C, Jin C, Xie Y, Xiang M. Prognostic Value of Urinary N-Acetyl-β-d-Glucosaminidase as a Marker of Tubular Damage in Patients with Heart Failure and Mitral Regurgitation. Rev Cardiovasc Med 2023; 24:219. [PMID: 39076721 PMCID: PMC11266753 DOI: 10.31083/j.rcm2408219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 07/31/2024] Open
Abstract
Background Mitral regurgitation (MR) has a high prevalence and aggravates hypoperfusion and hypoxia in heart failure (HF). Renal tubular epithelial cells are sensitive to hypoxia, and therefore tubulointerstitial damage is quite common in HF. However, the correlation between tubular dysfunction and MR has not been studied. The aim of this work was to evaluate the prognostic significance of urinary N-acetyl- β -d-glucosaminidase (uNAG), a biomarker of renal tubular damage, in patients with HF and MR. Methods This was a prospective cohort study of 390 patients (mean age 64 years; 65.6% male) with uNAG measurement on admission (expressed as urinary NAG/urinary creatinine) and at least 1 year of follow-up data. The pre-defined primary endpoint was the composite of all-cause mortality or rehospitalization for HF after discharge. Cox regression analysis, restricted cubic splines, and subgroup analysis were used to investigate the prognostic value of uNAG modeled as a categorical (quartiles) or continuous (per SD increase) variable. Results A total of 153 (39.23%) patients reached the composite endpoint over a median follow-up time of 1.2 years. The uNAG level correlated with the severity of HF and with the incidence of adverse events. In a multivariable Cox regression model, each SD (13.80 U/g ⋅ Cr) of increased uNAG was associated with a 17% higher risk of death or HF rehospitalization (95% confidence interval, 2-33%, p = 0.022), and a 19% higher risk of HF rehospitalization (p = 0.027). Subgroup analysis revealed the associations between uNAG and poor prognosis were only significant in younger patients ( ≤ 65 years) and in patients without obvious cardiovascular comorbidities. Conclusions uNAG levels at admission were associated with the risk of adverse outcomes in patients with HF and MR. Additional studies are needed to further investigate the heart-kidney interaction.
Collapse
Affiliation(s)
- Tingting Zhao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| | - Guanzhong Chen
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| | - Shiyu Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| | - Chengchen Zhao
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| | - Chunna Jin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| | - Yao Xie
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| | - Meixiang Xiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang
University School of Medicine, 310009 Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Lupieri A, Nagata Y, Passos LSA, Beker-Greene D, Kirkwood KA, Wylie-Sears J, Alvandi Z, Higashi H, Hung JW, Singh SA, Bischoff J, Levine RA, Aikawa E. Integration of Functional Imaging, Cytometry, and Unbiased Proteomics Reveals New Features of Endothelial-to-Mesenchymal Transition in Ischemic Mitral Valve Regurgitation in Human Patients. Front Cardiovasc Med 2021; 8:688396. [PMID: 34458332 PMCID: PMC8387660 DOI: 10.3389/fcvm.2021.688396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Following myocardial infarction, mitral regurgitation (MR) is a common complication. Previous animal studies demonstrated the association of endothelial-to-mesenchymal transition (EndMT) with mitral valve (MV) remodeling. Nevertheless, little is known about how MV tissue responds to ischemic heart changes in humans. Methods: MVs were obtained by the Cardiothoracic Surgical Trials Network from 17 patients with ischemic mitral regurgitation (IMR). Echo-doppler imaging assessed MV function at time of resection. Cryosections of MVs were analyzed using a multi-faceted histology and immunofluorescence examination of cell populations. MVs were further analyzed using unbiased label-free proteomics. Echo-Doppler imaging, histo-cytometry measures and proteomic analysis were then integrated. Results: MVs from patients with greater MR exhibited proteomic changes associated with proteolysis-, inflammatory- and oxidative stress-related processes compared to MVs with less MR. Cryosections of MVs from patients with IMR displayed activated valvular interstitial cells (aVICs) and double positive CD31+ αSMA+ cells, a hallmark of EndMT. Univariable and multivariable association with echocardiography measures revealed a positive correlation of MR severity with both cellular and geometric changes (e.g., aVICs, EndMT, leaflet thickness, leaflet tenting). Finally, proteomic changes associated with EndMT showed gene-ontology enrichment in vesicle-, inflammatory- and oxidative stress-related processes. This discovery approach indicated new candidate proteins associated with EndMT regulation in IMR. Conclusion: We describe an atypical cellular composition and distinctive proteome of human MVs from patients with IMR, which highlighted new candidate proteins implicated in EndMT-related processes, associated with maladaptive MV fibrotic remodeling.
Collapse
Affiliation(s)
- Adrien Lupieri
- Division of Cardiovascular Medicine, Center for Excellence in Vascular Biology and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Livia S A Passos
- Division of Cardiovascular Medicine, Center for Excellence in Vascular Biology and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Dakota Beker-Greene
- Division of Cardiovascular Medicine, Center for Excellence in Vascular Biology and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Katherine A Kirkwood
- Department of Population Health Science and Policy, Icahn School of Medicine, International Center for Health Outcomes and Innovation Research, New York, NY, United States
| | - Jill Wylie-Sears
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Department of Surgery and Harvard Medical School, Boston, MA, United States
| | - Zahra Alvandi
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Department of Surgery and Harvard Medical School, Boston, MA, United States
| | - Hideyuki Higashi
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Judy W Hung
- Echocardiography Laboratory, Division of Cardiology and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Sasha A Singh
- Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Joyce Bischoff
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Department of Surgery and Harvard Medical School, Boston, MA, United States
| | - Robert A Levine
- Cardiac Ultrasound Laboratory and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Center for Excellence in Vascular Biology and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Division of Cardiovascular Medicine, Center for Interdisciplinary Cardiovascular Sciences and Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Department of Human Pathology, Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
3
|
Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation. J Clin Med 2020; 9:jcm9051348. [PMID: 32380651 PMCID: PMC7290430 DOI: 10.3390/jcm9051348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
The management of mitral valve regurgitation (MR), a common valve disease, represents a challenge in clinical practice, since the indication for either surgical or percutaneous valve replacement or repair are guided by symptoms and by echocardiographic parameters which are not always feasible. In this complex scenario, the use of natriuretic peptide (NP) levels would serve as an additive diagnostic and prognostic tool. These biomarkers contribute to monitoring the progression of the valve disease, even before the development of hemodynamic consequences in a preclinical stage of myocardial damage. They may contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations, thus requiring surgical management rather than a conservative approach. This article provides a comprehensive overview of the available evidence on the role of NPs in the management, risk evaluation, and prognostic assessment of patients with MR both before and after surgical or percutaneous valve repair. Despite largely positive evidence, a series of controversial findings exist on this relevant topic. Recent clinical trials failed to assess the role of NPs following the interventional procedure. Future larger studies are required to enable the introduction of NP levels into the guidelines for the management of MR.
Collapse
|