Original Article
The role of biomarkers in dilated cardiomyopathy: Assessment of clinical severity and reverse remodeling
O papel dos biomarcadores na miocardiopatia dilatada – avaliação de gravidade clínica e remodelagem reversa
Sandra Amorima,c,, , Manuel Campeloa,c, Brenda Mouraa, Elisabete Martinsa,c, João Rodriguesa, Isaac Barrosob, Margarida Fariab, Tiago Guimarãesb,c, Filipe Macedoa,c, José Silva-Cardosoa,c, Maria Júlia Maciela,c
a Cardiology Department, Centro Hospitalar São João, Porto, Portugal
b Clinical Pathology Department, Centro Hospitalar São João, Porto, Portugal
c Porto Medical School, Porto, Portugal
Recebido 14 Setembro 2016, Aceitaram 21 Fevereiro 2017
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Abstract
Introduction

Biomarkers in dilated cardiomyopathy (DCM) reflect various pathobiological processes, including neurohormonal activation, oxidative stress, matrix remodeling, myocyte injury and myocyte stretch. We assessed the role of biomarkers in clinical and echocardiographic parameters and in left ventricular (LV) reverse remodeling (LVRR).

Methods

In this prospective study of 50 DCM patients (28 men, aged 59±10 years) with LV ejection fraction (LVEF) <40%, LVRR was defined as an increase of >10 U in LVEF after optimal medical therapy.

Results

Baseline LVEF was 25.4±9.8% and LV end-diastolic diameter (LVEDD)/body surface area (BSA) was 34.2±4.5 mm/m2. LVRR occurred in 34% of patients within 17.6±15.6 months. No correlation was found between B-type natriuretic peptide (BNP), 25-hydroxyvitamin D (25(OH)D), CA-125, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) [Lp(a)], noradrenaline, adrenaline, renin or aldosterone and LVRR. Patients in NYHA class III or IV, with pulmonary congestion or ankle edema, had higher CA-125, cystatin C, BNP and hs-CRP levels (p<0.05). CA-125 was correlated with BNP (r=0.61), hs-CRP (r=0.56) and uric acid (r=0.52) (all p=0.01). BNP correlated directly with LVEDD (r=0.49), LV volumes (r=0.51), pulmonary artery systolic pressure (PASP) (r=0.43) and E/e′ (r=0.31), and was inversely correlated with LVEF (r=-0.50) and e′ velocity (r=-0.32) (p<0.05). CA-125 was positively correlated with left atrial volume/BSA (r=0.46), E/A ratio (r=0.60) and PASP (r=0.49) (p<0.05).

Conclusions

No correlation was found between biomarkers and LVRR, but CA-125, BNP and hs-CRP were predictors of clinical severity and congestion. BNP correlated with parameters of systolic and diastolic dysfunction, while CA-125 correlated with measures of diastolic dysfunction.

Resumo
Introdução

Os biomarcadores na miocardiopatia dilatada (DCM) refletem vários processos fisiopatológicos: ativação neuro-hormonal, stresse oxidativo, remodelagem da matriz extracelular, lesão e estiramento miocitários. Procurámos associar biomarcadores com parâmetros clínicos, ecocardiográficos e com a reversão da remodelagem do ventrículo esquerdo (LVRR).

Métodos

Estudo prospetivo de 50 doentes com DCM (28 homens, idade 59±10 anos) com fração de ejeção ventricular esquerda (LVEF) <40%. A LVRR definiu-se como aumento>10 U da LVEF, após a terapêutica médica otimizada.

Resultados

A LVEF basal foi de 25,4±9,8% e o diâmetro do VE (LVD)/BSA de 34,2±4,5 mm/m2. A LVRR ocorreu em 34%, em 17,6±15,6 meses. Não houve correlação entre BNP, 25-OH-vit D, CA 125, hsCRP, Lp(a), noradrenalina, adrenalina, renina, aldosterona e LVRR. Doentes em classe NYHA (III-IV), com congestão pulmonar ou edema periférico apresentaram níveis mais elevados de CA 125, cistatina C, BNP e hsCRP (p<0,05). O CA 125 correlacionou-se com níveis de BNP (r=0,61), hsCRP (r=0,56) e ácido úrico (r=0,52) (p=0,01). O BNP relacionou-se diretamente com LVD (r=0,49), volume VE (r=0,51), PSAP (r=0,43), razão E/e′ (r=0,31); e inversamente com LVEF (r=-0,50) e vel. e′ (r=-0,32) (p<0,05). O CA 125 correlacionou-se com o volume AE/BSA (r=0,46), razão E/A (r=0,60) e PSAP (r=0,49) (p<0,05).

Conclusões

Não houve correlação entre biomarcadores e LVRR, contudo, o CA125, BNP e hsCRP foram preditores de gravidade clínica e de congestão. O BNP relacionou-se com parâmetros de disfunção sistólica e diastólica, enquanto o CA 125 se relacionou com medidas de disfunção diastólica.

Keywords
Biomarkers, Dilated cardiomyopathy, Reverse remodeling
Palavras-chave
Biomarcadores, Miocardiopatia dilatada, Remodelagem reversa

Métricas

  • Impact Factor: 1,195(2016)
  • 5-years Impact Factor: 0,728
  • SCImago Journal Rank (SJR):0,29
  • Source Normalized Impact per Paper (SNIP):0,398