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
Affiliations
Alexandre Mebazaa
Department of Anesthesiology and Critical Care, Assistance Publique des Hopitaux de Paris, Paris, France
Kestutis Stasaitis
Department of Emergency Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
Renata Juknevičienė
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Justas Simonavičius
Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Aurimas Mikalauskas
Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Kamilė Čerlinskaitė-Bajorė
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Mattia Arrigo
Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland
Vytautas Juknevičius
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Irina Alitoit-Marrote
Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Denis Kablučko
Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Loreta Bagdonaitė
Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Dalius Vitkus
Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Mindaugas Balčiūnas
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Gitana Zuozienė
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Jūratė Barysienė
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Diana Žaliaduonytė
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Aušra Kavoliūnienė
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Jelena Čelutkienė
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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.
