BMJ Open (Sep 2022)

Soluble CD146 in the detection and grading of intravascular and tissue congestion in patients with acute dyspnoea: analysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort

  • Alexandre Mebazaa,
  • Kestutis Stasaitis,
  • Renata Juknevičienė,
  • Justas Simonavičius,
  • Aurimas Mikalauskas,
  • Kamilė Čerlinskaitė-Bajorė,
  • Mattia Arrigo,
  • Vytautas Juknevičius,
  • Irina Alitoit-Marrote,
  • Denis Kablučko,
  • Loreta Bagdonaitė,
  • Dalius Vitkus,
  • Mindaugas Balčiūnas,
  • Gitana Zuozienė,
  • Jūratė Barysienė,
  • Diana Žaliaduonytė,
  • Aušra Kavoliūnienė,
  • Jelena Čelutkienė

DOI
https://doi.org/10.1136/bmjopen-2022-061611
Journal volume & issue
Vol. 12, no. 9

Abstract

Read online

Objectives To evaluate the potential of soluble cluster of differentiation 146 (sCD146) in the detection and grading of congestion in patients with acute dyspnoea.Design Subanalysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort.Setting Two Lithuanian university centres.Participants Adult patients with acute dyspnoea admitted to the emergency department.Methods Congestion was assessed using clinical and sonographic parameters. All patients underwent sCD146 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing.Results The median value of sCD146 concentration in the study cohort (n=437) was 405 (IQR 315–509) ng/mL. sCD146 was higher in patients with peripheral oedema than in those without (median (IQR) 472 (373–535) vs 400 (304–501) ng/mL, p=0.009) and with pulmonary rales than in those without (439 (335–528) vs 394 (296–484) ng/mL, p=0.001). We found a parallel increase of estimated right atrial pressure (eRAP) and sCD146 concentration: sCD146 was 337 (300–425), 404 (290–489) and 477 (363–572) ng/mL in patients with normal, moderately elevated and high eRAP, respectively (p=0.001). In patients with low NT-proBNP, high sCD146 distinguished a subgroup with a higher prevalence of oedema as compared with patients with low levels of both biomarkers (76.0% vs 41.0%, p=0.010). Moreover, high sCD146 indicated a higher prevalence of elevated eRAP, irrespective of NT-proBNP concentration (p<0.05).Conclusion sCD146 concentration reflects the degree of intravascular and tissue congestion assessed by clinical and echocardiographic indices, with this association maintained in patients with low NT-proBNP. Our data support the notion that NT-proBNP might represent heart stretch while sCD146 rather represents peripheral venous congestion.