Arrigo Mattia, Truong Quynh A, Onat Duygu, Szymonifka Jackie, Gayat Etienne, Tolppanen Heli, Sadoune Malha, Demmer Ryan T, Wong Ka Y, Launay Jean Marie, Samuel Jane-Lise, Cohen-Solal Alain, Januzzi James L, Singh Jagmeet P, Colombo Paolo C, Mebazaa Alexandre
INSERM UMR-S 942, Paris, France.
Université Paris Diderot, PRES Sorbonne Paris Cité, France; Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Paris, France.
Clin Chem. 2017 Jan;63(1):386-393. doi: 10.1373/clinchem.2016.260471. Epub 2016 Oct 25.
Soluble CD146 (sCD146), is an endothelial marker with similar diagnostic power as natriuretic peptides in decompensated heart failure (HF). While natriuretic peptides are released by the failing heart, sCD146 may be released by veins in response to stretch induced by systemic congestion in HF. This study investigated the source, effects of vascular stress on release and prognostic properties of sCD146 in HF.
In a peripheral venous stress study, plasma concentrations of sCD146 and N-terminal probrain natriuretic-peptide (NT-proBNP) were measured in 44 HF patients at baseline and after 90 min of unilateral forearm venous congestion. In addition, sCD146 and NT-proBNP were measured in peripheral vein (PV) and coronary sinus (CS) blood samples of 137 HF patients and the transcardiac gradient was calculated. Those patients were followed for major adverse cardiovascular events (MACE) during 2 years.
The induction of venous stress was associated with a pronounced increase in circulating concentrations of sCD146 in the congested arm (+60 μg/L) compared to the control arm (+16 μg/L, P = 0.025), while no difference in NT-proBNP concentrations was seen. In contrast to positive transcardiac gradient for NT-proBNP, median sCD146 concentrations were lower in CS than in PV (396 vs 434, P < 0.001), indicating a predominantly extracardiac source of sCD146. Finally, increased PV concentrations of sCD146 were associated with higher risk of MACE at 2 years.
Soluble CD146 is released from the peripheral vasculature in response to venous stretch and may reflect systemic congestion in chronic HF patients.
可溶性CD146（sCD146）是一种内皮标志物，在失代偿性心力衰竭（HF）中具有与利钠肽相似的诊断能力。虽然利钠肽由衰竭的心脏释放，但sCD146可能由静脉释放，以响应HF中全身充血引起的拉伸。本研究调查了HF中sCD146的来源、血管应激对其释放的影响及预后特性。
在一项外周静脉应激研究中，测量了44例HF患者在基线时以及单侧前臂静脉充血90分钟后的血浆sCD146和N末端脑钠肽前体（NT-proBNP）浓度。此外，测量了137例HF患者外周静脉（PV）和冠状窦（CS）血样中的sCD146和NT-proBNP，并计算了跨心脏梯度。对这些患者进行了2年的主要不良心血管事件（MACE）随访。
与对照臂（+16μg/L，P = 0.025）相比，静脉应激诱导导致充血臂中sCD146的循环浓度显著增加（+60μg/L），而NT-proBNP浓度未见差异。与NT-proBNP的正向跨心脏梯度相反，CS中sCD146的中位浓度低于PV（396对434，P < 0.001），表明sCD146主要来源于心脏外。最后，PV中sCD146浓度升高与2年时发生MACE的较高风险相关。
可溶性CD146响应静脉拉伸而从外周血管系统释放，可能反映慢性HF患者的全身充血情况。
