Preoperative soluble cluster of differentiation 40 ligand level is associated with outcome of pulmonary endarterectomy

Figures

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  sCD40L has a higher AUC for predicting poor surgical outcome in CTEPH compared with CRP or D-dimer.

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  Figure 1. The difference in soluble CD40 ligand (sCD40L) between control subjects and patients with chronic thromboembolic pulmonary hypertension (CTEPH). sCD40L is significantly higher in patients with CTEPH compared with controls (mean, 2.2 ± 3.1 ng/mL vs 0.5 ± 0.5 ng/mL; P = .009).

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  Figure 2. A, Preoperative soluble CD40 ligand (sCD40L) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are alive compared with those who died in the hospital. “alive” on the horizontal line indicates the subjects without operation-related death, and “death” indicates the subjects with operation-related death. The upper and lower borders of the box represent the upper and lower quartiles. The middle horizontal line represents the median. The upper and lower whiskers represent the maximum and minimum values of nonoutliers. Extra dots represent outliers. Preoperative sCD40L is significantly higher in the patients with operation-related deaths (mean, 6.8 ± 9.2 ng/mL vs 1.9 ± 2.1 ng/mL; P = .02). B, Correlation between preoperative sCD40L and postoperative cardiac index (CI). Preoperative sCD40L is correlated with postoperative CI (P = .02).

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  Figure 3. Area under the curve (AUC) for predicting poor surgical outcome by preoperative soluble CD40 ligand (sCD40L), C-reactive protein (CRP), and D-dimer levels. Preoperative sCD40L has a higher AUC value for predicting poor surgical outcome in chronic thromboembolic pulmonary hypertension than preoperative CRP or D-dimer.

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  Figure 4. Ninety patients with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent pulmonary endarterectomy (PEA) were divided into good and poor surgical outcome groups. We examined the relationship between preoperative soluble CD40 ligand (sCD40L) level and surgical outcome. A high preoperative sCD40L level was correlated with poor surgical outcome independent of other preoperative parameters. The area under the blood concentration time curve AUC value of preoperative sCD40L for predicting poor surgical outcome was higher than that of D-dimer and CRP. Preoperative sCD40L level of CTEPH patients could be a promising biomarker related to surgical outcome of PEA. CI, Cardiac index; PVR, pulmonary vascular resistance; RAP, right atrial pressure; mPAP, mean pulmonary arterial pressure; PAWP, pulmonary artery wedge pressure; PvO2, mixed venous oxygen pressure; BNP, brain natriuretic peptide; CRP, C-reactive protein; AUC, area under the curve.

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  Figure E1. The comparison of preoperative sCD40L among Jamieson classification. Patients with Jamieson classification type 1 and type 3 had higher sCD40L than that in patients with Jamieson classification type 2. sCD40L, Soluble CD40 ligand.