通过 MRproANP 和 sCD146 评估经皮二尖瓣交界分离术的疗效。
Assessment of successful percutaneous mitral commissurotomy by MRproANP and sCD146.
机构信息
Besancon University Hospital, and EA3920, University of Burgundy Franche-Comté, Besancon, France.
INSERM UMR-S 942, Paris, France.
出版信息
BMC Cardiovasc Disord. 2020 Apr 5;20(1):157. doi: 10.1186/s12872-020-01435-y.
BACKGROUND
We studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146 (sCD146), in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success.
METHODS
Biomarkers were tested in 40 patients the day before and the day after PMC. Success was defined as mitral valve area ≥ 1.5 cm; or an increase of ≥0.5 cm2 in mitral valve area associated with echocardiographic mitral regurgitation <grade 3-4 post-PMC.
RESULTS
Average age was 63.5 ± 12.7 years; 32(80%) were female. Before PMC, mean valve area was 1.1 ± 0.2 cm, mean gradient 9.1 ± 3.5 mmHg. PMC was successful in 30 (75%) and unsuccessful in 10 (25%). PMC yielded a significant reduction in MR-proANP and sCD146, driven by a significant reduction in these biomarkers in patients with successful procedure, whereas no reduction was observed in patients with unsuccessful procedure. A significant correlation was found between changes in plasma sCD146 and the relative change in mitral valve area. Elevated pre-procedural sPAP correlated with high sCD146, and accordingly, a significant correlation between the decrease in sPAP and sCD146 after PMC was shown.
CONCLUSIONS
MR-proANP and plasma sCD146 decreased significantly immediately after successful PMC. They appear to be markers of immediate success of PMC and of the hemodynamic improvement achieved by this procedure in patients with MS.
TRIAL REGISTRATION
This study is part of the cohorts registered with ClinicalTrials.gov on June 16, 2011 under the number NCT01374880.
背景
我们研究了 4 种心血管生物标志物（BNP、NT-proBNP；中膜前心房 NP[MR-proANP]；可溶性内皮 CD146[sCD146]）在接受经皮二尖瓣交界切开术（PMC）的重度二尖瓣狭窄患者中的血浆浓度变化，以确定潜在的手术成功标志物。
方法
在 PMC 前一天和后一天对 40 名患者进行了生物标志物检测。成功定义为二尖瓣瓣口面积≥1.5cm；或二尖瓣瓣口面积增加≥0.5cm2，同时经超声心动图检查术后二尖瓣反流<3-4 级。
结果
平均年龄为 63.5±12.7 岁；32 名（80%）为女性。在 PMC 之前，平均瓣口面积为 1.1±0.2cm，平均梯度为 9.1±3.5mmHg。30 例（75%）手术成功，10 例（25%）手术失败。PMC 使 MR-proANP 和 sCD146 显著降低，这主要归因于手术成功患者的这些生物标志物显著降低，而手术失败患者的生物标志物则没有降低。在血浆 sCD146 的变化与二尖瓣瓣口面积的相对变化之间发现了显著的相关性。术前 sPAP 升高与 sCD146 升高相关，因此，在 PMC 后 sPAP 和 sCD146 的下降之间显示出显著的相关性。
结论
MR-proANP 和血浆 sCD146 在 PMC 成功后即刻显著降低。它们似乎是 PMC 即刻成功的标志物，也是该手术在 MS 患者中实现的血流动力学改善的标志物。
试验注册
本研究是 2011 年 6 月 16 日在 ClinicalTrials.gov 注册的队列研究的一部分，注册号为 NCT01374880。
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