Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Cardiac biomarkers as indicators of right ventricular dysfunction and recovery in CTEPH – A cardiac magnetic resonance imaging study
S. Kriechbaum1, J.-M. Vietheer1, C. Wiedenroth2, F. Rudolph3, M. Barde1, J. S. Wolter1, M. Haas1, U. Fischer-Rasokat1, A. Rolf1, C. W. Hamm4, E. Mayer2, S. Guth2, T. Keller5, F. Roller6, C. Liebetrau1, für die Studiengruppen: BioReg, SFB-CRC1213
1Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 2Thoraxchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim; 3Kardiologie / Experimentelle Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 4Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 5Medizinische Klinik I, Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 6Radiologie, Justus Liebig Universität Giessen, Gießen;
BACKGROUND:
In chronic thromboembolic pulmonary hypertension (CTEPH), right heart failure determines outcome. Balloon pulmonary angioplasty (BPA) therapy allows right heart recovery, which can be monitored by cardiac magnetic resonance imaging (CMR). This study determined whether serum levels of cardiac biomarkers [N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-regional pro-atrial natriuretic peptide (MR-proANP), soluble suppression of tumorigenicity 2 (sST2), pregnancy-associated plasma protein-A (PAPP-A)] are associated with CMR findings in CTEPH patients prior to and after BPA therapy.

METHODS:
This observational cohort study included 23 CTEPH patients who underwent BPA therapy and completed a 6-month follow-up. Biomarker levels were compared with findings for right heart morphology and function derived from CMR.

RESULTS:
The 23 patients underwent 130 BPA sessions [median 6 (5-7) per patient]. Pulmonary hemodynamics improved after BPA therapy [PVR: 7.4 (6.0-9.0) vs. 4.9 (3.5-6.0) WU, p<0.001; meanPAP 41 (38-48) vs. 32 (28-37) mmHg, p<0.001]. CMR findings indicated maladaptive right heart remodeling and its recovery after therapy [RVEDV 191±65 ml vs. 154±42 ml (p=0.001); RVESV 127±55 ml vs. 83±36 ml (p<0.001); RVEF 36±11% vs. 48±9% (p<0.001)]. Circulating levels of NT-proBNP, MR-proANP, sST2, and PAPP-A correlated with right heart parameters at baseline. Biomarker level cut-offs [NT-proBNP 347 ng/L (AUC 0.81), MR-proANP 230 pg/L (AUC 0.73), PAPP-A 14.5 mU/L (AUC 0.84), sST2 51.9 ng/ml (AUC 0.79)] identified patients with a RVEF ≤35% at baseline, a known predictor of worse outcome. None of the patients with all biomarker levels below these cut-off values had an RVEF ≤35% at baseline.
After therapy, the majority of patients showed an improved RVEF, with 13 (57%) patients reaching a normalization >50%.  The dynamics of NT-proBNP, MR-proANP, and sST2 correlated with the improvement in RVEF after therapy.

CONCLUSION:
In CTEPH patients, CMR findings illustrate right heart failure and its recovery after BPA therapy. Cardiac biomarker levels correlate with right heart parameters and are able to identify patients with a severely reduced RVEF. Moreover, the dynamics of cardiac biomarkers correlated with the relative improvement of RVEF after therapy.
https://dgk.org/kongress_programme/jt2021/aP1423.html