Usefulness of soluble endoglin as a noninvasive measure of left ventricular filling pressure in heart failure.
Usefulness of soluble endoglin as a noninvasive measure of left ventricular filling pressure in heart failure.
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DOI：
10.1016/j.amjcard.2010.08.018
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发表时间：
2010-12-15
影响因子：
2.8
通讯作者：
Mendelsohn, Michael E.
中科院分区：
文献类型：
--
作者：
Kapur, Navin K.;Heffernan, Kevin S.;Yunis, Adil A.;Parpos, Peter;Kiernan, Michael S.;Sahasrabudhe, Nikhil A.;Kimmelstiel, Carey D.;Kass, David A.;Karas, Richard H.;Mendelsohn, Michael E.
进行性左心室（LV）功能障碍诱导细胞因子转化生长因子β（TGF β 1）的表达。内皮糖蛋白（CD 105）是一种TGF β 1共受体，作为可溶性内皮糖蛋白（sEng）释放到循环中。本研究的目的是评估心力衰竭患者血清sEng水平，并确定sEng检测左心室舒张末期压（LVEDP）升高的预测价值。我们连续检测了82例疑似左室功能不全的患者的sEng水平，这些患者通过心导管检查确定了左心充盈压。在这些受试者中，sEng水平与LVEDP相关（R=0.689; p<0.0001），与LV射血分数（LVEF）无关。使用接受手术特征（ROC）曲线，sEng水平预测LVEDP≥ 16 mmHg，曲线下面积（AUC）为0.85，超过目前用于心力衰竭诊断的生物标志物心房利钠肽和脑利钠肽的实测AUC（ANP：0.68; BNP：0.65，p<0.01，分别vs sEng）。在10例接受有创血流动力学监测指导的心力衰竭药物治疗的受试者中，肺毛细血管楔压降低与sEng水平降低相关（R=0.75，p=0.008）。最后，与25名健康对照者相比，疑似左室功能障碍受试者的sEng水平升高（分别为3589±588 vs 4257±966 pg/mL，p<0.005），并与纽约心脏协会分级（NYHA; R=0.501，p<0.001）直接相关。总之，无论LVEF如何，LVEDP和NYHA分级升高的患者循环sEng水平均升高。可溶性内皮糖蛋白水平也随着利尿后心脏充盈压降低而降低。这些发现将循环sEng确定为左心充盈压升高的敏感指标。
Progressive left ventricular (LV) dysfunction induces expression of the cytokine transforming growth factor-beta (TGFb1). Endoglin (CD105) is a TGFb1 co-receptor that is released into the circulation as soluble endoglin (sEng). The objective of this study was to assess serum levels of sEng in heart failure and to identify the predictive value of sEng for detecting elevated left ventricular end-diastolic pressures (LVEDP). We measured sEng levels in 82 consecutive patients with suspected LV dysfunction referred for determination of left heart filling pressures by cardiac catheterization. Among these subjects sEng levels correlated with LVEDP (R=0.689; p<0.0001) irrespective of LV ejection fraction (LVEF). Using a receiving operative characteristic (ROC) curve, sEng levels predicted an LVEDP≥16mmHg with an area-under-the-curve (AUC) of 0.85, exceeding measured AUCs for both atrial- and brain-natriuretic peptide, currently used biomarkers for heart failure diagnosis (ANP:0.68; BNP:0.65, p<0.01 vs sEng respectively). In 10 subjects receiving medical therapy for heart failure guided by invasive hemodynamic monitoring, decreased pulmonary capillary wedge pressure was associated with a reduced sEng level (R=0.75, p=0.008). Finally, compared to 25 healthy controls, sEng levels were elevated in subjects with suspected LV dysfunction (3589±588 vs 4257±966 pg/mL, respectively, p<0.005) and correlated directly with New York Heart Association class (NYHA; R=0.501, p<0.001). In conclusion, circulating levels of sEng are elevated in patients with increased LVEDP and NYHA class, irrespective of LVEF. Soluble endoglin levels also decrease in association with reduced cardiac filling pressure after diuresis. These findings identify circulating sEng as a sensitive measure of elevated left heart filling pressure.
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影响因子：
8.3
作者：
Rodríguez-Peña, A;Eleno, N;López-Novoa, JM
通讯作者：
López-Novoa, JM
影响因子：
8.3
作者：
Zhu, YH;Sun, YJ;Greenberg, DA
通讯作者：
Greenberg, DA
影响因子：
82.9
作者：
Zeisberg, Elisabeth M.;Tarnavski, Oleg;Kalluri, Raghu
通讯作者：
Kalluri, Raghu
影响因子：
82.9
作者：
Venkatesha, Shivalingappa;Toporsian, Mourad;Karumanchi, S. Ananth
通讯作者：
Karumanchi, S. Ananth
影响因子：
18.2
作者：
Larsen, A. I.;Dickstein, K.;Hall, C.
通讯作者：
Hall, C.