Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany.
Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany.
PLoS One. 2018 Sep 25;13(9):e0204683. doi: 10.1371/journal.pone.0204683. eCollection 2018.
Balloon pulmonary angioplasty (BPA) is an interventional treatment modality for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Therapy monitoring, based on non-invasive biomarkers, is a clinical challenge. This post-hoc study aimed to assess dynamics of high-sensitivity cardiac troponin T (hs-cTnT) as a marker for myocardial damage and its relation to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker for cardiac wall stress.
This study included 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between 3/2014 and 3/2017. Biomarker measurement was performed consecutively prior to each BPA and at 6-MFU. In total, the 51 patients underwent an average of 5 BPA procedures. The 6-month survival rate was 96.1%. The baseline (BL) meanPAP (39.5±12.1mmHg) and PVR (515.8±219.2dyn×sec×cm-5) decreased significantly within the 6-MFU (meanPAP: 32.6±12.6mmHg, P<0.001; PVR: 396.9±182.6dyn×sec×cm-5, P<0.001). At BL, the median hs-cTnT level was 11 (IQR 6-16) ng/L and the median NT-proBNP level was 820 (IQR 153-1872) ng/L. The levels of both biomarkers decreased steadily after every BPA, showing the first significant difference after the first procedure. Within the 6-MFU, hs-cTnT levels (7 [IQR 5-12] ng/L; P<0.001) and NT-proBNP levels (159 [IQR 84-464] ng/l; P<0.001) continued to decrease. The hs-cTnT levels correlated with the PVR (rrs = 0.42; p = 0.005), the meanPAP (rrs = 0.32; p = 0.029) and the NT-proBNP (rrs = 0.51; p<0.001) levels at BL.
Non-invasive biomarker measurement provides valuable evidence for the decreasing impairment of myocardial function and structure during BPA therapy. Changes in hs-cTNT levels are suggestive for a reduction in ongoing myocardial damage.
球囊肺动脉成形术（BPA）是一种治疗不能手术的慢性血栓栓塞性肺动脉高压（CTEPH）的介入治疗方法。基于非侵入性生物标志物的治疗监测是一项临床挑战。本回顾性研究旨在评估高敏心肌肌钙蛋白 T（hs-cTnT）作为心肌损伤标志物的动态变化及其与 N 末端脑利钠肽前体（NT-proBNP）水平作为心肌壁张力标志物的关系。
本研究纳入了 2014 年 3 月至 2017 年 3 月期间连续接受 BPA 治疗并完成 6 个月随访（6-MFU）的 51 例连续患者。在每次 BPA 之前和 6-MFU 时连续进行生物标志物测量。51 例患者共接受了平均 5 次 BPA 治疗。6 个月生存率为 96.1%。基线（BL）平均肺动脉压（39.5±12.1mmHg）和肺血管阻力（PVR）（515.8±219.2dyn×sec×cm-5）在 6-MFU 内显著降低（平均肺动脉压：32.6±12.6mmHg，P<0.001；PVR：396.9±182.6dyn×sec×cm-5，P<0.001）。BL 时，hs-cTnT 水平中位数为 11（IQR 6-16）ng/L，NT-proBNP 水平中位数为 820（IQR 153-1872）ng/L。两种生物标志物在每次 BPA 后均持续下降，首次显著差异出现在第一次 BPA 后。在 6-MFU 内，hs-cTnT 水平（7 [IQR 5-12] ng/L；P<0.001）和 NT-proBNP 水平（159 [IQR 84-464] ng/L；P<0.001）持续下降。hs-cTnT 水平与 BL 时的 PVR（rrs = 0.42；p = 0.005）、平均肺动脉压（rrs = 0.32；p = 0.029）和 NT-proBNP（rrs = 0.51；p<0.001）水平相关。
非侵入性生物标志物测量为 BPA 治疗期间心肌功能和结构损害的降低提供了有价值的证据。hs-cTNT 水平的变化提示持续心肌损伤的减少。
