Serum Activin A Level and 1‐Year Mortality in Atrial Septal Defect‐Associated Pulmonary Artery Hypertension: A Case‐Control Study From the COHARD‐PH Registry

Background Serum activin A level is a promising prognostic biomarker for pulmonary artery hypertension (PAH). In this study, we aim to investigate serum activin A levels and their associations with 1‐year mortality in atrial septal defect (ASD)–associated PAH patients. Methods This was a case‐control study of adult Indonesian patients diagnosed with ASD‐PAH from the COHARD‐PH registry. Cases were subjects deceased in a 1‐year follow‐up, whereas controls were those survived. Serum activin A was measured at the index of diagnosis. The demographics, clinical parameters, hemodynamic, and mortality data were retrieved from the registry database up to a 1‐year follow‐up period. These data were compared and analyzed between the case and control groups. Results From the 1‐year follow‐up data, 44 cases (deceased group) and 102 controls (survived group) were identified. The deceased group had significant lower bodyweight ( p < 0.001), body mass index (BMI) ( p < 0.01), with higher NT‐proBNP level (< 0.0001), higher proportion of Eisenmenger syndrome ( p < 0.05), higher right atrial (RA) area ( p < 0.0001), lower tricuspid annular plane systolic excursion (TAPSE) ( p < 0.01), and a significant increase in mean right atrial pressure (mRAP) (< 0.0001). There was no difference in the activin A level between deceased and survivors (506.3 ± 259.1 pg/mL vs. 536.1 ± 293.9 pg/mL, p > 0.05, respectively). Moreover, activin A level did not associate with the mortality risk among subjects (OR = 0.9996; 95% CI: 0.9982–1.00087; p > 0.05). Conclusion Serum activin A level did not associate with 1‐year mortality in adult patients with ASD‐associated PAH.