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Vol. 153. Issue 6.
Pages 232-238 (September 2019)
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Vol. 153. Issue 6.
Pages 232-238 (September 2019)
Original article
DOI: 10.1016/j.medcle.2019.07.004
Mean velocity of the pulmonary artery estimated by cardiac magnetic resonance as an early prognostic predictor in heart failure
Velocidad media de la arteria pulmonar estimada por resonancia magnética cardiaca como predictor pronóstico precoz en insuficiencia cardiaca
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Blanca Trejo-Velascoa,
Corresponding author
, Francisco Ridocci-Sorianoa,b, María Pilar García-Gonzálezc, Andrés Mauricio Cubillos-Arangoa, Rafael Payá-Sorianoa,b, Óscar Fabregat-Andrésd
a Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
b Departamento de Medicina, Universitat de Valencia, Valencia, Spain
c Unidad de Imagen Cardiaca, ERESA, Valencia, Spain
d Servicio de Cardiología, Hospital IMED de Valencia, Burjassot, Valencia, Spain
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Figures (2)
Tables (4)
Table 1. Sample characteristics according to LVEF on admission.
Table 2. Sample characteristics according to the primary cardiovascular event.
Table 3. Sample characteristics according to mean pulmonary artery velocity (mPAv).
Table 4. Univariate and multivariate analysis.
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Abstract
Background and objective

To identify early, non-invasive prognostic indicators in heart failure (HF), with and without associated pulmonary hypertension, by means of cardiac magnetic resonance, and oxidative stress and anti-inflammatory biomarkers such as Trolox™ (antioxidant status) and IL-10 (anti-inflammatory cytokine).

Patients and methods

We prospectively included 70 patients admitted for new-onset HF. During index admission, mean velocity of the pulmonary artery (mvPA) was measured, and blood Trolox™ and IL-10 determined. The study sample was divided in two groups according to the optimal cut-off value for event prediction calculated by the ROC curve (mvPA=8cm/s), considering HF-readmission and all-cause mortality as the primary combined event.

Results

During a median follow-up of 290 days, 16 events occurred. In patients with preserved right ventricular (RV) function, mvPA ≤8cm/s was associated with a higher incidence of events during follow-up, Kaplan–Meier survival analysis (log rank 6.01, p=0.014). MvPA did not add prognostic value when RV dysfunction was already established. Trolox™ concentration was lower in patients with mvPA ≤8cm/s. Higher IL-10 expression was associated with a lower incidence of cardiovascular events during follow-up.

Conclusion

In HF patients, mvPA ≤8cm/s predicts a higher rate of cardiovascular events. Specifically, mvPA identifies a higher risk population among patients with preserved RV function, thus confirming its role as an early prognostic indicator. Lower Trolox™ concentration in the worse prognosis group concurs with previous studies on oxidative stress in pulmonary hypertension. Higher IL-10 concentration among patients free of cardiovascular events could be a reflection of its anti-inflammatory and thus protective role in HF.

Keywords:
Heart failure
Pulmonary hypertension
Right ventricle
Prognosis
Biomarkers
Cardiac magnetic resonance
Resumen
Introducción y objetivo

La hipertensión pulmonar asocia peor pronóstico en insuficiencia cardiaca (IC). En este estudio buscamos identificar predictores pronósticos no invasivos en IC con y sin hipertensión pulmonar asociada, mediante resonancia magnética cardiaca y determinación de marcadores de estrés oxidativo y antiinflamatorios.

Pacientes y métodos

Inclusión prospectiva de 70 pacientes ingresados por IC de comienzo, en los que se determinó la velocidad media de arteria pulmonar (vmAP) y la concentración sanguínea de Trolox™ (estatus antioxidante) e IL-10 (citocina antiinflamatoria). La muestra se dividió en dos grupos de acuerdo con el valor óptimo de vmAP para la predicción de sucesos calculados mediante curva ROC (vmAP=8cm/s), considerando los reingresos por IC y la mortalidad global como el suceso cardiovascular primario.

Resultados

Tras una mediana de seguimiento de 290 días se produjeron 16 episodios. La vmAP ≤8cm/s predijo una mayor incidencia de episodios en pacientes con función ventricular derecha conservada, no así en aquellos con disfunción ventricular derecha; análisis de supervivencia con curva de Kaplan-Meier, log rank 6,01, p=0,014. Los pacientes con vmAP ≤ 8cm/s presentaron niveles plasmáticos menores de Trolox™. Los pacientes con mayor concentración de IL-10 presentaron menor incidencia de episodios en el seguimiento.

Conclusión

La vmAP es un indicador pronóstico no invasivo precoz en IC con y sin hipertensión pulmonar asociada, previo al desarrollo de disfunción ventricular derecha. La menor concentración de Trolox™ en pacientes con vmAP ≤ 8cm/s refleja un mayor nivel de estrés oxidativo en pacientes de peor pronóstico, mientras que la mayor expresión de IL-10 en pacientes libres de eventos podría guardar relación con su efecto antiinflamatorio y potencialmente protector en IC.

Palabras clave:
Insuficiencia cardiaca
Hipertensión pulmonar
Ventrículo derecho
Pronóstico
Biomarcadores
Resonancia magnética cardiaca

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