Quantifying Hemodynamic Cardiac Stress and Cardiomyocyte Injury in Normotensive and Hypertensive Acute Heart Failure
Nikola Kozhuharov,
Eleni Michou,
Desiree Wussler,
Maria Belkin,
Corinna Heinisch,
Johan Lassus,
Krista Siirilä-Waris,
Harjola Veli-Pekka,
Nisha Arenja,
Thenral Socrates,
Albina Nowak,
Samyut Shrestha,
Julie Valerie Willi,
Ivo Strebel,
Danielle M. Gualandro,
Katharina Rentsch,
Micha T. Maeder,
Thomas Münzel,
Mucio Tavares de Oliveira Junior,
Arnold von Eckardstein,
Tobias Breidthardt,
Christian Mueller
Affiliations
Nikola Kozhuharov
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Eleni Michou
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Desiree Wussler
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Maria Belkin
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Corinna Heinisch
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Johan Lassus
Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, 00280 Helsinki, Finland
Krista Siirilä-Waris
Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, 00280 Helsinki, Finland
Harjola Veli-Pekka
Department of Emergency Care, Helsinki University Hospital, 00280 Helsinki, Finland
Nisha Arenja
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Thenral Socrates
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Albina Nowak
Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, 8091 Zürich, Switzerland
Samyut Shrestha
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Julie Valerie Willi
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Ivo Strebel
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Danielle M. Gualandro
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Katharina Rentsch
Department of Laboratory Medicine, University Hospital Basel, 4031 Basel, Switzerland
Micha T. Maeder
Department of Cardiology, Kantonsspital St. Gallen, 9000 St. Gallen, Switzerland
Thomas Münzel
University Medical Center, Johannes Gutenberg University Mainz, 55122 Mainz, Germany
Mucio Tavares de Oliveira Junior
Heart Institute (INCOR), University of Sao Paulo Medical School, Sao Paulo 01246-000, Brazil
Arnold von Eckardstein
Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, 8006 Zürich, Switzerland
Tobias Breidthardt
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Christian Mueller
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
Background: The characterization of the different pathophysiological mechanisms involved in normotensive versus hypertensive acute heart failure (AHF) might help to develop individualized treatments. Methods: The extent of hemodynamic cardiac stress and cardiomyocyte injury was quantified by measuring the B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) concentrations in 1152 patients presenting with centrally adjudicated AHF to the emergency department (ED) (derivation cohort). AHF was classified as normotensive with a systolic blood pressure (SBP) of 90–140 mmHg and hypertensive with SBP > 140 mmHg at presentation to the ED. Findings were externally validated in an independent AHF cohort (n = 324). Results: In the derivation cohort, with a median age of 79 years, 43% being women, 667 (58%) patients had normotensive and 485 (42%) patients hypertensive AHF. Hemodynamic cardiac stress, as quantified by the BNP and NT-proBNP, was significantly higher in normotensive as compared to hypertensive AHF [1105 (611–1956) versus 827 (448–1419) pg/mL, and 5890 (2959–12,162) versus 4068 (1986–8118) pg/mL, both p p p < 0.001). Normotensive patients with a high BNP, NT-proBNP, or hs-cTnT had the highest mortality. The findings were confirmed in the validation cohort. Conclusion: Biomarker profiling revealed a higher extent of hemodynamic stress and cardiomyocyte injury in patients with normotensive versus hypertensive AHF.
