Key result
Adding biomarkers to PA/BSA fails to improve pulmonary hypertension detection in severe aortic stenosis.
Why the study?
Pulmonary artery diameter relates to mortality in severe aortic stenosis, but whether combining established and novel cardiovascular biomarkers with the PA/BSA value can detect pulmonary hypertension was unclear.
Does combining cardiovascular biomarkers with PA/BSA improve the diagnostic precision for detecting pulmonary hypertension in patients with severe aortic stenosis undergoing TAVR?
Observational (n=188)
Yes
Does combining cardiovascular biomarkers with PA/BSA improve the diagnostic precision for detecting pulmonary hypertension in patients with severe aortic stenosis undergoing TAVR?
Effect estimate: AUC 0.727 (95% CI 0.590-0.864)
p-value: p=0.004
Combining PA/BSA with cardiovascular biomarkers does not significantly improve the diagnostic precision for detecting pulmonary hypertension in patients with severe aortic stenosis undergoing TAVR.
Combining biomarkers with PA/BSA yields no diagnostic gain in severe AS; leaves open whether refined panels merit prospective validation.
(1) Background: Currently, echocardiography is the primary non-invasive diagnostic method used to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery pressure (sPAP). Other radiological methods have been a focus of research in the past couple of years, as it was shown that by determining the pulmonary artery (PA) diameter, prognostic statements concerning overall mortality could be made in these patients. This study compared established and novel cardiovascular biomarkers with the PA/BSA value to detect PH in patients with severe AS. (2) Methods: The study cohort comprised 188 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), who were then divided into two groups based on PA/BSA values obtained through CT-angiography. The presence of PH was defined as a PA/BSA ≥ 16.6 mm/m2 (n = 81), and absence as a PA/BSA < 16.6 mm/m2 (n = 107). Blood samples were taken before TAVR to assess cardiovascular biomarkers used in this study, namely brain natriuretic peptide (BNP), cardiac troponin I (cTnI), high-sensitive troponin (hsTN), soluble suppression of tumorigenesis-2 (sST2), growth/differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2), and soluble urokinase-type plasminogen activator receptor (suPAR). (3) Results: Patients with a PA/BSA ≥ 16.6 mm/m2 showed significantly higher levels of BNP (p = <0.001), GDF-15 (p = 0.040), and H-FABP (p = 0.007). The other investigated cardiovascular biomarkers did not significantly differ between the two groups. To predict a PA/BSA ≥ 16.6 mm/m2, cut-off values for the biomarkers were calculated. Here, GDF-15 (p = 0.029; cut-off 1172.0 pg/mL) and BNP (p < 0.001; cut-off 2194.0 pg/mL) showed significant results. Consequently, analyses of combined biomarkers were performed, which yielded IGF-BP2 + BNP (AUC = 0.721; 95%CI = 0.585−0.857; p = 0.004) as the best result of the two-way analyses and GDF-15 + IGF-BP2 + BNP (AUC = 0.727; 95%CI = 0.590−0.864; p = 0.004) as the best result of the three-way analyses. No significant difference regarding the 1-year survival between patients with PA/BSA < 16.6 mm/m2 and patients with PA/BSA ≥ 16.6 mm/m2 was found (log-rank test: p = 0.452). (4) Conclusions: Although PA/BSA aims to reduce the bias of the PA value caused by different body compositions and sizes, it is still a controversial parameter for diagnosing PH. Combining the parameter with different cardiovascular biomarkers did not lead to a significant increase in the diagnostic precision for detecting PH in patients with severe AS.
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Kletzer et al. (2023) conducted an observational in Severe aortic valve stenosis with suspected pulmonary hypertension (n=188). Cardiovascular biomarkers (GDF-15, IGF-BP2, BNP) vs. PA/BSA alone was evaluated on Prediction of pulmonary hypertension (PA/BSA ≥ 16.6 mm/m2) using GDF-15 + IGF-BP2 + BNP (AUC 0.727, 95% CI 0.590-0.864, p=0.004). Combining PA/BSA with cardiovascular biomarkers such as GDF-15, IGF-BP2, and BNP (AUC 0.727) did not lead to a significant increase in diagnostic precision for detecting pulmonary hypertension in patients with severe aortic stenosis.
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