Peplinski Brandon S, Houston Brian A, Bluemke David A, Kawut Steven M, Kolb Todd M, Kronmal Richard A, Lima Joao A C, Ralph David D, Rayner Samuel G, Steinberg Zachary L, Tedford Ryan J, Leary Peter J
University of Washington, Department of Medicine, Seattle, WA.
Medical University of South Carolina, Department of Medicine, Charleston, SC.
J Card Fail. 2021 Jul;27(7):786-795. doi: 10.1016/j.cardfail.2021.04.001. Epub 2021 Apr 17.
Angiopoietin-1 and 2 (Ang1, Ang2) are important mediators of angiogenesis. Angiopoietin levels are perturbed in cardiovascular disease, but it is unclear whether angiopoietin signaling is causative, an adaptive response, or merely epiphenomenon of disease activity.
In a cohort free of cardiovascular disease at baseline (Multi-Ethnic Study of Atherosclerosis [MESA]), relationships between angiopoietins, cardiac morphology, and subsequent incidence of heart failure or cardiovascular death were evaluated. In cohorts with pulmonary arterial hypertension or left heart disease, associations between angiopoietins, invasive hemodynamics, and adverse clinical outcomes were evaluated. In MESA, Ang2 was associated with a higher incidence of heart failure or cardiovascular death (hazard ratio 1.21 per standard deviation, P < .001). Ang2 was associated with increased right atrial pressure (pulmonary arterial hypertension cohort) and increased wedge pressure and right atrial pressure (left heart disease cohort). Elevated Ang2 was associated with mortality in the pulmonary arterial hypertension cohort.
Ang2 was associated with incident heart failure or death among adults without cardiovascular disease at baseline and with disease severity in individuals with existing heart failure. Our finding that Ang2 is increased before disease onset and that elevations reflect disease severity, suggests Ang2 may contribute to heart failure pathogenesis.
血管生成素-1和2（Ang1、Ang2）是血管生成的重要介质。血管生成素水平在心血管疾病中会受到干扰，但尚不清楚血管生成素信号传导是病因、适应性反应，还是仅仅是疾病活动的附带现象。
在基线时无心血管疾病的队列（动脉粥样硬化多民族研究[MESA]）中，评估了血管生成素、心脏形态与随后发生心力衰竭或心血管死亡之间的关系。在患有肺动脉高压或左心疾病的队列中，评估了血管生成素、有创血流动力学与不良临床结局之间的关联。在MESA中，Ang2与心力衰竭或心血管死亡的较高发生率相关（每标准差风险比1.21，P<0.001）。Ang2与右心房压力升高（肺动脉高压队列）以及楔压和右心房压力升高（左心疾病队列）相关。Ang2升高与肺动脉高压队列中的死亡率相关。
Ang2与基线时无心血管疾病的成年人发生心力衰竭或死亡以及现有心力衰竭患者的疾病严重程度相关。我们发现Ang2在疾病发作前升高且升高反映疾病严重程度，这表明Ang2可能促成心力衰竭的发病机制。
