Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?

Abstract Background In chronic thromboembolic pulmonary hypertension (CTEPH) impaired pulmonary hemodynamics lead to right heart failure. Natriuretic peptides reflect hemodynamic disease severity. Pregnancy-associated plasma protein-A (PAPP-A) might address another aspect of CTEPH - chronic tissue i...

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Main Authors: Steffen D. Kriechbaum, Felix Rudolph, Christoph B. Wiedenroth, Lisa Mielzarek, Moritz Haas, Stefan Guth, Christian W. Hamm, Eckhard Mayer, Christoph Liebetrau, Till Keller
Format: Article
Language:English
Published: BMC 2020-08-01
Series:Respiratory Research
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12931-020-01472-3
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author Steffen D. Kriechbaum
Felix Rudolph
Christoph B. Wiedenroth
Lisa Mielzarek
Moritz Haas
Stefan Guth
Christian W. Hamm
Eckhard Mayer
Christoph Liebetrau
Till Keller
author_facet Steffen D. Kriechbaum
Felix Rudolph
Christoph B. Wiedenroth
Lisa Mielzarek
Moritz Haas
Stefan Guth
Christian W. Hamm
Eckhard Mayer
Christoph Liebetrau
Till Keller
author_sort Steffen D. Kriechbaum
collection DOAJ
description Abstract Background In chronic thromboembolic pulmonary hypertension (CTEPH) impaired pulmonary hemodynamics lead to right heart failure. Natriuretic peptides reflect hemodynamic disease severity. Pregnancy-associated plasma protein-A (PAPP-A) might address another aspect of CTEPH - chronic tissue injury and inflammation. This study assessed dynamics of PAPP-A in CTEPH patients who undergo therapy with pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA). Methods The study included a total of 125 CTEPH patients scheduled for treatment (55 PEA/ 70 BPA) and a control group of 58 patients with pulmonary hypertension other than CTEPH. Biomarker measurement was performed at baseline and follow-up in the CTEPH cohort, prior to each BPA in the BPA cohort and once in the control group. Results The median PAPP-A level was slightly higher (p = 0.05) in CTEPH patients [13.8 (11.0–18.6) mU/L], than in the control group [12.6 (8.6–16.5) mU/L], without a difference between the BPA and PEA group (p = 0.437) and without a correlation to mean pulmonary artery pressure (p = 0.188), pulmonary vascular resistance (p = 0.893), cardiac index (p = 0.821) and right atrial pressure (p = 0.596). PEA and BPA therapy decreased the mean pulmonary artery pressure (p < 0.001) and pulmonary vascular resistance (p < 0.001) and improved the WHO-functional-class (baseline: I:0/II:25/III:80/IV:20 vs. follow-up: I:55/II:58/III:10/IV:2). PAPP-A levels decreased after PEA [13.5 (9.5–17.5) vs. 11.3 (9.8–13.6) mU/L; p = 0.003) and BPA treatment [14.3 (11.2–18.9) vs. 11.1 (9.7–13.3) mU/L; p < 0.001). The decrease of PAPP-A levels is delayed in comparison to N-terminal pro-B-type natriuretic peptide. Conclusion PAPP-A is overexpressed in CTEPH and decrease significantly after surgical or interventional therapy, however without association to hemodynamics. Further investigation is needed to define the underlying mechanism of PAPP-A expression and changes after therapy in CTEPH.
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spelling doaj.art-886e88b8ec454346831c62245b9662cd2022-12-22T00:07:19ZengBMCRespiratory Research1465-993X2020-08-012111610.1186/s12931-020-01472-3Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?Steffen D. Kriechbaum0Felix Rudolph1Christoph B. Wiedenroth2Lisa Mielzarek3Moritz Haas4Stefan Guth5Christian W. Hamm6Eckhard Mayer7Christoph Liebetrau8Till Keller9Department of Cardiology, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterMedical Clinic I, Division of Cardiology, Justus Liebig University GiessenDepartment of Thoracic Surgery, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Cardiology, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Cardiology, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Thoracic Surgery, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Cardiology, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Thoracic Surgery, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Cardiology, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterDepartment of Cardiology, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax CenterAbstract Background In chronic thromboembolic pulmonary hypertension (CTEPH) impaired pulmonary hemodynamics lead to right heart failure. Natriuretic peptides reflect hemodynamic disease severity. Pregnancy-associated plasma protein-A (PAPP-A) might address another aspect of CTEPH - chronic tissue injury and inflammation. This study assessed dynamics of PAPP-A in CTEPH patients who undergo therapy with pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA). Methods The study included a total of 125 CTEPH patients scheduled for treatment (55 PEA/ 70 BPA) and a control group of 58 patients with pulmonary hypertension other than CTEPH. Biomarker measurement was performed at baseline and follow-up in the CTEPH cohort, prior to each BPA in the BPA cohort and once in the control group. Results The median PAPP-A level was slightly higher (p = 0.05) in CTEPH patients [13.8 (11.0–18.6) mU/L], than in the control group [12.6 (8.6–16.5) mU/L], without a difference between the BPA and PEA group (p = 0.437) and without a correlation to mean pulmonary artery pressure (p = 0.188), pulmonary vascular resistance (p = 0.893), cardiac index (p = 0.821) and right atrial pressure (p = 0.596). PEA and BPA therapy decreased the mean pulmonary artery pressure (p < 0.001) and pulmonary vascular resistance (p < 0.001) and improved the WHO-functional-class (baseline: I:0/II:25/III:80/IV:20 vs. follow-up: I:55/II:58/III:10/IV:2). PAPP-A levels decreased after PEA [13.5 (9.5–17.5) vs. 11.3 (9.8–13.6) mU/L; p = 0.003) and BPA treatment [14.3 (11.2–18.9) vs. 11.1 (9.7–13.3) mU/L; p < 0.001). The decrease of PAPP-A levels is delayed in comparison to N-terminal pro-B-type natriuretic peptide. Conclusion PAPP-A is overexpressed in CTEPH and decrease significantly after surgical or interventional therapy, however without association to hemodynamics. Further investigation is needed to define the underlying mechanism of PAPP-A expression and changes after therapy in CTEPH.http://link.springer.com/article/10.1186/s12931-020-01472-3PAPP-APregnancy-associated plasma protein APappalysin-1BPAPEACTEPH
spellingShingle Steffen D. Kriechbaum
Felix Rudolph
Christoph B. Wiedenroth
Lisa Mielzarek
Moritz Haas
Stefan Guth
Christian W. Hamm
Eckhard Mayer
Christoph Liebetrau
Till Keller
Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?
Respiratory Research
PAPP-A
Pregnancy-associated plasma protein A
Pappalysin-1
BPA
PEA
CTEPH
title Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?
title_full Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?
title_fullStr Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?
title_full_unstemmed Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?
title_short Pregnancy-associated plasma protein A – a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension?
title_sort pregnancy associated plasma protein a a new indicator of pulmonary vascular remodeling in chronic thromboembolic pulmonary hypertension
topic PAPP-A
Pregnancy-associated plasma protein A
Pappalysin-1
BPA
PEA
CTEPH
url http://link.springer.com/article/10.1186/s12931-020-01472-3
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