Do endothelial markers possess a role in the evaluation of decongestion and prediction of adverse cardiovascular events in hospitalised patients with acute decompensated heart failure?
J Jurica, M J Pec, T Bolek, B Focko, I Sagova, J Sokol, I Skornova, P Tudik, J Stasko, M Samos, M MokanAbstract
Introduction
Clinical practice requires objective and precise assessment of congestion in patients with acute decompensated heart failure (ADHF), which can sometimes be demanding, especially in elderly patients with several comorbidities. Clinicians often rely on their clinical experience and point-of-care ultrasonography, both of which pose a risk of subjective and inaccurate interpretation. Furthermore, it is often very difficult to predict or assess the effect of decongestive therapy in a polymorbid patient. There is a lack of laboratory markers that could be utilised in evaluating congestion or predicting HF-related adverse events. ADHF represents the leading cause of hospitalisations in our country, and each hospitalisation for ADHF dramatically increases the risk of mortality. Discharging patients with ADHF too early, before complete decongestion also increases the risk of readmission and adverse events. Endothelial markers (EM), such as vascular endothelial growth factor (VEGF), vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) have been proposed as potential diagnostic tools in the management of patients with ADHF.
Purpose
The aim of this study was to assess the plasma levels of selected markers of endothelial function in patients with ADHF at admission and after decongestion.
Methods
A pilot prospective and observational study was carried out enrolling ADHF patients requiring hospital admission. The plasma concentrations of VEGF, VCAM-1 and ICAM-1 were determined at admission and after decongestion. A subgroup analysis of the results was performed with respect to the left ventricular ejection fraction (LVEF). In addition, the patients were followed for 12 months for HF-related adverse events (cardiovascular death or HF-related rehospitalisation).
Results
39 patients were enrolled; 28 of them presented with preserved LVEF and 11 with reduced LVEF. There were no statistically significant differences detected in the observed EM levels during decongestive therapy (comparing plasma levels obtained prior to and after decongestion): VEGF [183.0(82.9-276.0) vs. 181.0(89.1-253.0) pg/mL; p=0.988]; VCAM-1 [2692.0(1382.0-3870.0) vs. 2554.0(1660.0-3612.0) ng/mL; p=0.845]; and ICAM-1 [389.0(240.0-564.0) vs. 391.0(232.0-693.0) ng/mL; p=0.180]. The value of LVEF (either preserved or reduced) did not significantly affect the plasma levels of EM. Lastly, no EM was found to significantly predict HF-related adverse events in the 12-month follow-up period.
Conclusion
This study did not identify any significant changes in the plasma levels of EM in patients with ADHF, nor any significant impact on HF-related adverse events in the 12-month follow-up period.