Eugene S J Tan, Hyungwon Choi, Christopher R DeFilippi, Yen-Yee Oon, Siew-Pang Chan, Lingli Gong, Josephine B Lunaria, Oi-Wah Liew, Jenny Pek-Ching Chong, Edgar Lik-Wui Tay, Wern-Miin Soo, James Wei-Luen Yip, Quek Wei Yong, Evelyn Min Lee, Poh Shuan Daniel Yeo, Zee Pin Ding, Hak Chiaw Tang, See Hooi Ewe, Calvin W L Chin, Siang Chew Chai, Ping Ping Goh, Lee Fong Ling, Hean Yee Ong, A Mark Richards, Lieng-Hsi Ling
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Plasma proteomic profiling may add prognostic value in these patients.</p><p><strong>Methods and results: </strong>Proximity extension assays (Olink) of 183 circulating cardiovascular and inflammatory proteins were performed in a prospective follow-up study of 122 asymptomatic/minimally symptomatic patients (mean±SD age, 69.1±10.9 years; 61% men) with moderate to severe aortic stenosis and preserved left ventricular ejection fraction. Protein signatures of higher-risk echocardiographic subgroups were determined. Associations of proteins with the primary composite outcome (heart failure hospitalization, progression to New York Heart Association class III-IV, or all-cause mortality) were evaluated using competing risk analyses, with aortic valve replacement being the competing risk. Network analysis unveiled mutually exclusive communities of proteins and echocardiographic parameters, connected only through NT-proBNP (N-terminal pro-B-type natriuretic peptide). Members of the tumor necrosis factor receptor superfamily (TNFRSF1A, TNFRSF1B, and TNFRSF14), and trefoil factor-3 were major hub proteins among the circulating biomarkers. Left ventricular global longitudinal strain >-15% was associated with higher levels of proteins, primarily of inflammation and immune regulation, whereas aortic valve area <1 cm<sup>2</sup>, E/e' >15, and left atrial reservoir strain <20% were associated with higher levels of NT-proBNP. Of 14 proteins associated with the primary end point, phospholipase-C, C-X-C motif chemokine-9, and interleukin-10 receptor subunit β demonstrated the highest hazard ratios after adjusting for clinical factors (<i>q</i><0.05).</p><p><strong>Conclusions: </strong>Plasma proteins involved in inflammation and immune regulation were differentially expressed in patients with aortic stenosis with reduced left ventricular global longitudinal strain, and associated with adverse clinical outcomes. 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Members of the tumor necrosis factor receptor superfamily (TNFRSF1A, TNFRSF1B, and TNFRSF14), and trefoil factor-3 were major hub proteins among the circulating biomarkers. Left ventricular global longitudinal strain >-15% was associated with higher levels of proteins, primarily of inflammation and immune regulation, whereas aortic valve area <1 cm<sup>2</sup>, E/e' >15, and left atrial reservoir strain <20% were associated with higher levels of NT-proBNP. Of 14 proteins associated with the primary end point, phospholipase-C, C-X-C motif chemokine-9, and interleukin-10 receptor subunit β demonstrated the highest hazard ratios after adjusting for clinical factors (<i>q</i><0.05).</p><p><strong>Conclusions: </strong>Plasma proteins involved in inflammation and immune regulation were differentially expressed in patients with aortic stenosis with reduced left ventricular global longitudinal strain, and associated with adverse clinical outcomes. 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引用次数: 0
摘要
背景:主动脉瓣狭窄的超声心动图指标可能无法全面反映疾病的发病率。血浆蛋白质组分析可能会增加这些患者的预后价值:在一项前瞻性随访研究中,对122名无症状/轻微症状的中重度主动脉瓣狭窄且左室射血分数保留的患者(平均年龄(±SD)为69.1±10.9岁;61%为男性)进行了183种循环心血管和炎症蛋白的邻近延伸测定(Olink)。确定了高风险超声心动图亚组的蛋白质特征。采用竞争风险分析法评估了蛋白质与主要综合结果(心力衰竭住院、进展至纽约心脏协会 III-IV 级或全因死亡率)的相关性,主动脉瓣置换术是竞争风险。网络分析揭示了蛋白质和超声心动图参数的互斥群落,这些群落仅通过NT-proBNP(N末端前B型钠尿肽)相连。肿瘤坏死因子受体超家族成员(TNFRSF1A、TNFRSF1B和TNFRSF14)和三叶因子-3是循环生物标志物中的主要枢纽蛋白。左心室整体纵向应变>-15%与较高水平的蛋白质(主要是炎症和免疫调节蛋白)有关,而主动脉瓣面积2、E/e'>15和左心房贮器应变q则与较高水平的蛋白质(主要是炎症和免疫调节蛋白)有关:在左心室整体纵向应变降低的主动脉瓣狭窄患者中,参与炎症和免疫调节的血浆蛋白有不同程度的表达,并与不良临床结局相关。将它们纳入主动脉瓣狭窄风险分层值得进一步评估。
Circulating Plasma Proteins in Aortic Stenosis: Associations With Severity, Myocardial Response, and Clinical Outcomes.
Background: Echocardiographic indexes of aortic stenosis may not comprehensively reflect disease morbidity. Plasma proteomic profiling may add prognostic value in these patients.
Methods and results: Proximity extension assays (Olink) of 183 circulating cardiovascular and inflammatory proteins were performed in a prospective follow-up study of 122 asymptomatic/minimally symptomatic patients (mean±SD age, 69.1±10.9 years; 61% men) with moderate to severe aortic stenosis and preserved left ventricular ejection fraction. Protein signatures of higher-risk echocardiographic subgroups were determined. Associations of proteins with the primary composite outcome (heart failure hospitalization, progression to New York Heart Association class III-IV, or all-cause mortality) were evaluated using competing risk analyses, with aortic valve replacement being the competing risk. Network analysis unveiled mutually exclusive communities of proteins and echocardiographic parameters, connected only through NT-proBNP (N-terminal pro-B-type natriuretic peptide). Members of the tumor necrosis factor receptor superfamily (TNFRSF1A, TNFRSF1B, and TNFRSF14), and trefoil factor-3 were major hub proteins among the circulating biomarkers. Left ventricular global longitudinal strain >-15% was associated with higher levels of proteins, primarily of inflammation and immune regulation, whereas aortic valve area <1 cm2, E/e' >15, and left atrial reservoir strain <20% were associated with higher levels of NT-proBNP. Of 14 proteins associated with the primary end point, phospholipase-C, C-X-C motif chemokine-9, and interleukin-10 receptor subunit β demonstrated the highest hazard ratios after adjusting for clinical factors (q<0.05).
Conclusions: Plasma proteins involved in inflammation and immune regulation were differentially expressed in patients with aortic stenosis with reduced left ventricular global longitudinal strain, and associated with adverse clinical outcomes. Their incorporation into aortic stenosis risk stratification warrants further assessment.
期刊介绍:
As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice.
JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.