Background:

Recent studies have shown that right ventricular (RV) dysfunction is associated with worse outcomes in patients with severe aortic stenosis (AS). Hence, it is important to develop diagnostic tools that can improve the detection of RV dysfunction in these patients. In previously published studies our research group showed that CILP1 is a biomarker of maladaptive RV remodeling in patients with pulmonary hypertension and ischemic cardiomyopathy.

Objectives:

The aim of the present analysis was to assess the utility of CILP1 as a biomarker of RV dysfunction in patients with severer AS and preserved systolic LV function.

Methods:

CILP1 plasma concentrations in 622 patients with severe aortic stenosis and LVEF ≥ 50% and 25 healthy controls were measured using a commercial enzyme-linked immunosorbend (ELISA) assay. Cardiac function and structure were assessed by transthoracic echocardiography.

Results:

CILP1 concentrations in the study cohort were higher as in the control group (p< 0,0001). CILP1 levels were also higher in patients with severe AS and TAPSE<17 mm (p<0,0001), RVEDd ≥ 40 mm (p=0,001) and PASP > 50 mmHg (p=0,004).  ROC analysis showed a good predictive power of CILP1 for TAPSE<15 mm (AUC=0,70) and TAPSE<14 mm (AUC=0,75). Higher CILP1 levels were associated with atrial fibrillation (p<0,001), prior cardiac decompensation (p<0,001) and NYHA≥III (p=0,04). There were no associations with LVEDd≥56 mm (p=0,64), LVEF≥60% (p=0,4), IVSD>12mm (p=0,22), coronary artery disease (p=0,19) or prior coronary intervention (p=0,18).

Conclusion:

Our data reveals that increased CILP1 levels in patients with severer AS and preserved systolic LV function are associated with systolic RV dysfunction, RV dilation and higher pulmonary pressures. Additionally, higher CILP1 concentrations were associated with heart failure symptoms and atrial fibrillation in this cohort, whereas there were no associations between CILP1 and LV parameters.