Key result
Elevated plasma levels of VEGF-D and HER4 in patients with end-stage heart failure decreased significantly (p < 0.0001) and normalized one year after heart transplantation, correlating with improved haemodynamics.
Why the study?
Receptor tyrosine kinases are implicated in cardiovascular growth and remodelling, but their plasma levels and associations with haemodynamic alterations in heart failure and related pulmonary hypertension following heart transplantation remained to be identified.
Does heart transplantation normalize elevated plasma tyrosine kinases VEGF-D and HER4 in end-stage heart failure patients?
Cohort (n=46)
No
Does heart transplantation normalize elevated plasma tyrosine kinases VEGF-D and HER4 in end-stage heart failure patients?
p-value: p=<0.0001
Elevated plasma VEGF-D and HER4 in end-stage heart failure normalize after heart transplantation, correlating with improved pulmonary hemodynamics and cardiac function, suggesting their potential role as biomarkers for passive pulmonary congestion and volume overload.
May track hemodynamic recovery after transplantation; leaves open prospective validation as HF biomarkers.
Receptor tyrosine kinases (RTKs) are implicated in cardiovascular growth and remodelling. We aimed to identify the plasma levels of RTKs and related proteins and their association with haemodynamic alterations in heart failure (HF) and related pulmonary hypertension (PH) following heart transplantation (HT). Using proximity extension assay, 28 RTKs and related proteins were analysed in plasma from 20 healthy controls and 26 HF patients before and 1-year after HT. In end-stage HF, out of 28 RTKs, plasma vascular endothelial growth factor-D (VEGF-D) and human epidermal growth factor-4 (HER4) were elevated compared to controls ( p < 0.001), but decreased ( p < 0.0001) and normalised after HT. Following HT, plasma changes (Δ) of VEGF-D correlated with Δmean pulmonary artery pressure ( r s = 0.65, p = 0.00049), Δpulmonary artery wedge pressure ( r s = 0.72, p < 0.0001), Δpulmonary arterial compliance (PAC) ( r s = − 0.52, p = 0.0083) and Δpulmonary vascular resistance (PVR) ( r s = 0.58, p = 0.0032). ΔHER4 correlated with Δmean right atrial pressure ( r s = 0.51, p = 0.012), ΔNT-proBNP ( r s = 0.48, p = 0.016) and Δcardiac index ( r s = − 0.56, p = 0.0044). In HF patients following HT, normalisation of VEGF-D reflected reversal of passive pulmonary congestion and restored PAC and PVR; whereas the normalisation of HER4 reflected decreased volume overload and improved cardiac function. The precise function of these proteins, their potential clinical use and pathophysiological relation in HF and related PH remain to be elucidated.
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Ahmed et al. (2020) conducted a cohort in End-stage heart failure and related pulmonary hypertension (n=46). Heart transplantation vs. Pre-transplantation baseline and healthy controls was evaluated on Plasma levels of VEGF-D and HER4 (p=<0.0001). Elevated plasma levels of VEGF-D and HER4 in patients with end-stage heart failure decreased significantly (p < 0.0001) and normalized one year after heart transplantation, correlating with improved haemodynamics.
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