Key result
A 3-way combination of BNP, H-FABP, and IGF-BP2 predicted an MPA diameter ≥29 mm (AUC 0.685; 95% CI 0.551-0.818; P=0.015), but combining MPA diameter with biomarkers did not improve PH detection.
Why the study?
Echocardiography is the standard noninvasive screening method for pulmonary hypertension in severe aortic valve stenosis, but radiological CT angiography assessment of main pulmonary artery diameter offers an alternative; the authors sought to evaluate cardiovascular biomarkers alongside MPA diameter to identify pulmonary hypertension.
Does the combination of cardiovascular biomarkers and main pulmonary artery diameter improve the detection of pulmonary hypertension in patients with severe aortic valve stenosis undergoing TAVR?
Observational (n=194)
Does the combination of cardiovascular biomarkers and main pulmonary artery diameter improve the detection of pulmonary hypertension in patients with severe aortic valve stenosis undergoing TAVR?
Effect estimate: AUC 0.685 (95% CI 0.551-0.818)
p-value: p=0.015
Combining cardiovascular biomarkers with main pulmonary artery diameter does not provide significant additional precision for detecting pulmonary hypertension in patients with severe aortic stenosis.
Combining biomarkers with MPA diameter does not improve PH detection in severe AS; leaves open targeted panel utility in prospective cohorts.
BACKGROUND: Echocardiography is currently the noninvasive method of choice to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery pressure (sPAP). However, radiological options are also available by determining the main pulmonary artery (MPA) diameter in the setting of CT angiography. The aim of the present study was to compare cardiovascular biomarkers with the MPA diameter to allow other ways of detecting PH in patients with severe AS. METHODS: One hundred ninety-four patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) were included in this study and were divided into two groups based on the CT-angiographically determined MPA diameter. In accordance with ESC guidelines, a cut-off value of 29 mm was determined in this study, with the absence of PH defined by an MPA diameter <29 mm (N79/194) and the presence of PH defined by an MPA diameter ≥29 mm (115/194). Immediately before interventional aortic valve replacement, blood samples were drawn from the subjects and relevant cardiovascular biomarkers such as BNP, cTnI, GDF-15, H-FABP, IGF-BP2 and suPAR were assessed. RESULTS: Patients with an MPA diameter ≥29 mm had significantly higher BNP (P=0.004), cTnI (P=0.039) and H-FABP (P=0.015) plasma levels, whereas GDF-15 (P=0.140), IGF-BP2 (P=0.088) and suPAR (P=0.140) showed no significant differences. In addition, cut-off values were calculated to predict an MPA diameter ≥29 mm. Significant results were shown with 1634.00 pg/mL for BNP (P=0.004), with 16.50 pg/mL for cTnI (P=0.039) and with 1.16 ng/mL for H-FABP (P=0.016). In a combined biomarker analysis, the 2-way combination of BNP and IGF-BP2 (AUC 0.671; 95%CI 0.538-0.805; P=0.023) and the 3-way combination of BNP, H-FABP and IGF-BP2 (AUC 0.685; 95%CI 0.551-0.818; P=0.015) showed the best results. Biomarker follow-up at 3 and 12 months after TAVR did not require additional information gain. Regarding 1-year survival, no significant difference could be detected between patients with an MPA diameter<29 mm compared to patients with ≥29 mm (log-rank test: P=0.262). CONCLUSIONS: The MPA diameter remains a controversial parameter for the detection of PH in patients with severe AS. Standing on its own, this non-invasive parameter may not be precise enough to detect PH accurately. Combining this parameter with several biomarkers did not provide significant additional information.
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Boxhammer et al. (2022) conducted an observational in severe aortic valve stenosis (n=194). Cardiovascular biomarkers (BNP, cTnI, GDF-15, H-FABP, IGF-BP2, suPAR) vs. MPA diameter <29 mm was evaluated on Prediction of an MPA diameter ≥29 mm using a 3-way combination of BNP, H-FABP and IGF-BP2 (AUC 0.685, 95% CI 0.551-0.818, p=0.015). A 3-way combination of BNP, H-FABP, and IGF-BP2 predicted an MPA diameter ≥29 mm (AUC 0.685; 95% CI 0.551-0.818; P=0.015), but combining MPA diameter with biomarkers did not improve PH detection.
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