Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension

Shah, Sanjiv J.; Thenappan, Thenappan; Rich, Stuart; Tian, Lu; Archer, Stephen L.; Gomberg‐Maitland, Mardi

doi:10.1161/circulationaha.107.719500

Cited by 117 publications

(105 citation statements)

References 41 publications

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“…An increase in serum creatinine level often reflects impaired renal perfusion (13,14). In our study, there was no relationship between creatinine level and right atrial pressure.…”

Section: Discussioncontrasting

confidence: 55%

What Levels of Uric Acid and NT-Probnp Predict Outcomes of Eisenmenger Syndrome in Children?

Pamukçu¹,

Yılmaz²,

Narın³

et al. 2016

Erciyes Med J

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Objective: Noninvasive methods for follow-up of pulmonary hypertensive children are limited. The main aim of this study was to determine the cutoff levels for uric acid and N-terminal pro-brain natriuretic peptide (NT-proBNP) for follow-up of Eisenmenger patients and their relationships with classical methods. To our best knowledge, this is the first study to investigate the levels of NT-proBNP and uric acid in pediatric Eisenmenger patients. Materials and Methods:Sixteen patients with Eisenmenger syndrome and 37 healthy children as controls were included in the study. The serum NT-proBNP and uric acid levels of the participants were measured. The echocardiography, six-minute walk test, and right cardiac catheterization data of the two groups were compared.Results: NT-proBNP>81.4 pg/mL and uric acid >3.5 mg/dL were found to be the most specific and sensitive points for predicting the severity of pulmonary hypertension in Eisenmenger syndrome. There was no significant difference between mean pulmonary arterial pressure and serum NT-proBNP level; however, the differences between pulmonary vascular resistance and serum NT-proBNP level and between mean pulmonary arterial pressure and serum NT-proBNP level were significant. There was no significant difference between NT-proBNP level and New York Heart Association functional classification or six-minute walk test distance. There was no significant difference between serum uric acid level and pulmonary vascular resistance, right atrial pressure, or mean pulmonary arterial pressure. Conclusion:It is too early to determine if serum biomarkers can replace classical diagnostic methods in Eisenmenger syndrome; further studies are required.

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“…An increase in serum creatinine level often reflects impaired renal perfusion (13,14). In our study, there was no relationship between creatinine level and right atrial pressure.…”

Section: Discussioncontrasting

confidence: 55%

What Levels of Uric Acid and NT-Probnp Predict Outcomes of Eisenmenger Syndrome in Children?

Pamukçu¹,

Yılmaz²,

Narın³

et al. 2016

Erciyes Med J

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“…Thus, the presence of underlying kidney disease might be higher than what is noted in our study in those patients with PH. Shah et al (26) reported that, among PH patients (n=500), higher serum creatinine was associated with higher death rates among those patients with RAP,10 mmHg. However, Shah et al (26) did not notice significant associations in those patients with RAP.10 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…Shah et al (26) reported that, among PH patients (n=500), higher serum creatinine was associated with higher death rates among those patients with RAP,10 mmHg. However, Shah et al (26) did not notice significant associations in those patients with RAP.10 mmHg. Data from the REVEAL revealed that renal insufficiency (assessed at the time of enrollment of participants into the registry) was associated with an increased risk for death (hazard ratio, 1.90; 95% CI, 1.33 to 2.72) (14).…”

Section: Discussionmentioning

confidence: 99%

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan

Wehbe

Heresi³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulmonary hypertension is associated with higher mortality rates. The associations of nondialysis-dependent CKD and all-cause mortality in patients with pulmonary hypertension were studied.Design, setting, participants, & measurements The study population included those patients who underwent right heart catheterization for confirmation of pulmonary hypertension between 1996 and January 2011. Pulmonary hypertension was defined as the presence of mean pulmonary artery pressure$25 mmHg at rest measured by right heart catheterization. CKD was defined as the presence of two measurements of eGFR,60 ml/min per 1.73 m 2 90 days apart. The risk factors associated with CKD as well as the association between CKD and death in those patients with pulmonary hypertension using logistic regression and Cox proportional hazard models were examined.Results Of 1088 patients with pulmonary hypertension, 388 (36%) patients had CKD: 340 patients had stage 3 CKD, and 48 (4%) patients had stage 4 CKD. In the multivariable analysis, older age, higher hemoglobin, and higher mean right atrial pressures were independently associated with CKD. During a median follow-up of 3.2 years (interquartile range=1.5-5.6 years), 559 patients died. After adjusting for relevant covariates, presence of stage 3 CKD (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.66) and stage 4 CKD (hazard ratio, 2.69; 95% confidence interval, 1.88 to 3.86) was associated with all-cause mortality in those patients with pulmonary hypertension. When eGFR was examined as a continuous measure, a 5 ml/min per 1.73 m 2 lower eGFR was associated with a 5% (95% confidence interval, 1.03 to 1.07) higher hazard for death. This higher risk with CKD was similar irrespective of demographics, left ventricular function, and pulmonary capillary wedge pressure. ConclusionIn a clinical population referred for right heart catheterization, presence of CKD was associated with higher all-cause mortality in those patients with pulmonary hypertension. Mechanisms that may underlie these associations warrant additional studies.

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“…We evaluated the relationship between serum ES and clinical markers of exercise performance and function, specifically 6 MWD and NYHA-FC, and serum chemistries previously linked to outcomes in PAH, notably NT-proBNP (18)(19)(20), creatinine (21), and serum sodium (22) ( Table 2).…”

Section: Serum Endostatin Correlates With Clinical Markers Of Diseasementioning

confidence: 99%

Serum Endostatin Is a Genetically Determined Predictor of Survival in Pulmonary Arterial Hypertension

Damico

Kolb

Valera

et al. 2015

Am J Respir Crit Care Med

102

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Rationale: Pulmonary arterial hypertension (PAH) is a medically incurable disease resulting in death from right ventricular (RV) failure. Both pulmonary vascular and RV remodeling are linked to dynamic changes in the microvasculature. Therefore, we hypothesized that circulating angiostatic factors could be linked to outcomes and represent novel biomarkers of disease severity in PAH.Objectives: We sought to determine the relationship of a potent angiostatic factor, endostatin (ES), with disease severity and mortality in PAH. Furthermore, we assessed genetic predictors of ES expression and/or function and their association with outcomes in PAH.Methods: We measured levels of serum ES in two independent cohorts of patients with PAH. Contemporaneous clinical data included New York Heart Association functional class, 6-minutewalk distance, invasive hemodynamics, and laboratory chemistries.Measurements and Main Results: Serum ES correlated with poor functional status, decreased exercise tolerance, and invasive hemodynamics variables. Furthermore, serum ES was a strong predictor of mortality. A loss-of-function, missense variant in the gene encoding ES, Col18a1, was linked to lower circulating protein and was independently associated with reduced mortality.Conclusions: Our data link increased expression of ES to disease severity in PAH and demonstrate a significant relationship with adverse outcomes. Circulating ES levels can be genetically influenced, implicating ES as a genetically determined modifier of disease severity impacting on survival. These observations support serum ES as a potential biomarker in PAH with the capacity to predict poor outcomes. More importantly, this study implicates Col18a1/ES as a potential new therapeutic target in PAH.

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Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension

Cited by 117 publications

References 41 publications

What Levels of Uric Acid and NT-Probnp Predict Outcomes of Eisenmenger Syndrome in Children?

What Levels of Uric Acid and NT-Probnp Predict Outcomes of Eisenmenger Syndrome in Children?

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Serum Endostatin Is a Genetically Determined Predictor of Survival in Pulmonary Arterial Hypertension

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