Soluble ST2 as a Biomarker for Early Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension Treated with Balloon Pulmonary Angioplasty

Background: The aim of the study was to assess soluble ST2 (sST2) concentration and its dynamic changes in the periprocedural period in patients with chronic thromboembolic pulmonary hypertension (CTEPH) treated with balloon pulmonary angioplasty (BPA). Methods: We prospectively analyzed 57 procedures of BPA performed in 37 patients with CTEPH. Biomarkers, such as N-terminal pro B-type natriuretic peptide (NT-proBNP), troponin T (TnT), and sST2 were assessed at four time points: Before the BPA procedure, 24 h and 48 h after the procedure, and at the discharge from hospital. Each postprocedural period was assessed for complications. Results: Before the BPA procedure, median sST2 concentration was 26.56 ng/mL (IQR: 16.66–40.83 ng/mL). sST2 concentration was significantly higher 24 h and 48 h after the BPA compared to the baseline measurements (33.31 ng/mL (IQR: 20.81–62.56), p = 0.000 and 27.45 ng/mL (IQR: 17.66–54.45), p = 0.028, respectively). sST2 level 24 h after the BPA procedure was significantly higher in the group with complications compared to the group without complications in the postprocedural period (97.66 ng/mL (IQR: 53.07–126.18) vs. 26.86 ng/mL (IQR: 19.10–40.12), p = 0.000). Conclusions: sST2 concentration in patients with CTEPH treated with BPA changes significantly in the postprocedural period and is significantly higher in the group with complications in postprocedural period.

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Abstract 13252: High-sensitivity Troponin T is a Useful Biomarker of Hemodynamics Response After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension

Circulation ◽

10.1161/circ.132.suppl_3.13252 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Mai Kimura ◽

Takashi Kohno ◽

Takashi Kawakami ◽

Taku Inohara ◽

Makoto Takei ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Cardiac Troponin ◽

Troponin T ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

High Sensitivity ◽

Left Heart Failure ◽

High Sensitivity Troponin ◽

Balloon Pulmonary Angioplasty ◽

Thromboembolic Pulmonary Hypertension ◽

High Sensitivity Troponin T

Introduction: Balloon pulmonary angioplasty (BPA) improves hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Cardiac troponin is a marker of ongoing myocardial damage, and reflects hemodynamics in patients with left-heart failure. However, the clinical significance of cardiac troponin in CTEPH patients treated with BPA was unknown. We hypothesized that cardiac troponin is a surrogate marker of hemodynamic response in CTEPH patients who underwent BPA. Methods and Results: We analyzed 63 consecutive CTEPH patients who underwent BPA procedures, and measured high-sensitivity troponin T (hsTnT) level using electrochemiluminescence immunoassay before and after BPA from November 2012 to May 2015 (age; 62.8±14.3 years, female; n=41, number of target vessels per patient; 13.3±2.4, total sessions per patient; 5.9±1.9). Elevation of baseline hsTnT was associated with older age (p<0.05). Patients with baseline hsTnT level > median value (0.012 ng/ml) was associated with higher right atrium pressure (7.5±3.8 vs 5.9±2.2 mmHg, p<0.05), mean pulmonary artery pressure (mPAP; 41.4±11.0 vs 34.9±9.6 mmHg, p<0.05), pulmonary vascular resistance (PVR; 926.7±663.3 vs 731.1±931.8 dynes•sec•cm-5, p<0.05) and lower pulmonary capillary wedge pressure (8.2±2.9 vs 10.4±4.9 mmHg, p<0.05) and six-minute walk distance (265.9±98.9 vs 342.0±80.9 m, p<0.05), but not associated with cardiac output. BPA improved mPAP (from 38.1±10.7 to 21.1±5.6 mmHg, p<0.05) and PVR (from 823.6±828.2 to 292.8±129.6 dynes•sec•cm-5, p<0.05). HsTnT significantly decreased after BPA (from 0.015±0.012 to 0.012±0.009 ng/mL; p<0.05). Based on change of HsTnT after BPA, we divided the patients into two groups: HsTnT-decrease group (n=34) and HsTnT-increase or stable group (n=29). HsTnT-decrease group showed greater decreases in mPAP and PVR (delta mPAP 20.1±10.3 vs 13.3±11.3 mmHg, p<0.05, delta PVR 686.4±982.6 vs 352.3±452.5 dynes•sec•cm-5, p<0.05) after BPA. Conclusions: HsTnT level is a useful biomarker of hemodynamics severity, and change of hsTnT reflected improvement of hemodynamics in CTEPH patients who underwent BPA. Serial measurements of hsTnT could be a less-invasive and useful strategy to monitor therapeutic impact of BPA.

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