Ann Lab Med.  2016 Jul;36(4):300-305. 10.3343/alm.2016.36.4.300.

Plasma Levels of Soluble CD146 Reflect the Severity of Pulmonary Congestion Better Than Brain Natriuretic Peptide in Acute Coronary Syndrome

• Kubena P
• Arrigo M
• Parenica J
• Gayat E
• Sadoune M
• Ganovska E
• Pavlusova
• Littnerova S
• Spinar J
• Mebazaa A
• the GREAT Network

• KMID: 2373548
• DOI: http://doi.org/10.3343/alm.2016.36.4.300

Abstract

BACKGROUND
Acute heart failure negatively affects short-term outcomes of patients with acute coronary syndrome (ACS). Therefore, reliable and non-invasive assessment of pulmonary congestion is needed to select patients requiring more intensive monitoring and therapy. Since plasma levels of natriuretic peptides are influenced by myocardial ischemia, they might not reliably reflect congestion in the context of ACS. The novel endothelial biomarker, soluble CD146 (sCD146), presents discriminative power for detecting the cardiac origin of acute dyspnea similar to that of natriuretic peptides and is associated with systemic congestion. We evaluated the performance of sCD146 for the assessment of pulmonary congestion in the early phase of ACS.
METHODS
One thousand twenty-one consecutive patients with ACS were prospectively enrolled. Plasma levels of sCD146, brain natriuretic peptide (BNP), and high-sensitive troponin T were measured within 24 hr after the onset of chest pain. Pulmonary congestion on chest radiography was determined and classified in three groups according to the degree of congestion.
RESULTS
Nine hundred twenty-seven patients with ACS were analyzed. Ninety-two (10%) patients showed signs of pulmonary edema on chest radiography. Plasma levels of sCD146 reflected the radiological severity of pulmonary congestion. Higher plasma levels of sCD146 were associated with the worse degree of pulmonary congestion. In contrast to BNP, sCD146 levels were not affected by the level of troponin T.
CONCLUSIONS
The novel endothelial biomarker, sCD146, correlates with radiological severity of pulmonary congestion in the early phase of ACS and, in contrast to BNP, is not affected by the amount of myocardial cell necrosis.

Keyword

Acute coronary syndrome; Myocardial infarction; Pulmonary congestion; Pulmonary edema; sCD146

MeSH Terms

Acute Coronary Syndrome/*diagnosis/diagnostic imaging
Aged
Antigens, CD146/blood
Biomarkers/blood
Chest Pain/diagnostic imaging/*pathology
Electrocardiography
Enzyme-Linked Immunosorbent Assay
Female
Humans
Male
Middle Aged
Myocardial Infarction/diagnosis
Natriuretic Peptide, Brain/*blood
Severity of Illness Index
Troponin T/blood
Antigens, CD146
Biomarkers
Natriuretic Peptide, Brain
Troponin T

Figure

• 

  Fig. 1 Plasma levels of BNP and sCD146 according to the severity of pulmonary congestion. Increasing radiological evidence of pulmonary congestion is associated with higher levels of sCD146. Plasma levels of BNP show higher dispersion and do not reflect the severity of pulmonary congestion. Median and interquartile range are displayed.Abbreviations: BNP, brain natriuretic peptide; sCD146, soluble CD146; NS, not significant.

• 

  Fig. 2 Plasma levels of BNP and sCD146 according to troponin T levels. Increasing levels of troponin T are associated with higher BNP, but similar or lower levels of sCD146. Median and interquartile range are displayed.Abbreviations: BNP, brain natriuretic peptide; sCD146, soluble CD146; NS, not significant.

Reference

1. Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, OPTIMIZE-HF Investigators and Hospitals, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008; 168:847–854. PMID: 18443260.

2. Bahit MC, Lopes RD, Clare RM, Newby LK, Pieper KS, Van de Werf F, et al. Heart failure complicating non-ST-segment elevation acute coronary syndrome: timing, predictors, and clinical outcomes. JACC Heart Fail. 2013; 1:223–229. PMID: 24621874.

3. Heeschen C, Hamm CW, Mitrovic V, Lantelme NH, White HD. Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Investigators. N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients with acute coronary syndromes. Circulation. 2004; 110:3206–3212. PMID: 15533869.

4. Sabatine MS, Morrow DA, de Lemos JA, Omland T, Desai MY, Tanasijevic M, et al. Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol. 2004; 44:1988–1995. PMID: 15542281.

5. Gayat E, Caillard A, Laribi S, Mueller C, Sadoune M, Seronde MF, et al. Soluble CD146, a new endothelial biomarker of acutely decompensated heart failure. Int J Cardiol. 2015; 199:241–247. PMID: 26209827.

6. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012; 33:2551–2567. PMID: 22922414.

7. Bardin N, Moal V, Anfosso F, Daniel L, Brunet P, Sampol J, et al. Soluble CD146, a novel endothelial marker, is increased in physiopathological settings linked to endothelial junctional alteration. Thromb Haemost. 2003; 90:915–920. PMID: 14597988.

8. Picano E, Gargani L, Gheorghiade M. Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart Fail Rev. 2010; 15:63–72. PMID: 19504345.

9. Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, et al. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015; 17:544–558. PMID: 25999021.