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

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; Kęstutis Stašaitis; Aušra Kavoliūnienė; Alexandre Mebazaa; Jelena Čelutkienė

doi:10.1136/bmjopen-2022-061611

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

BMJ Open. 2022 Sep 1;12(9):e061611. doi: 10.1136/bmjopen-2022-061611.

Authors

Renata Juknevičienė^{1

2}, Justas Simonavičius^{3

4}, Aurimas Mikalauskas³, Kamilė Čerlinskaitė-Bajorė^{1

5

6}, Mattia Arrigo^{7

8}, Vytautas Juknevičius^{1

3}, Irina Alitoit-Marrote³, Denis Kablučko³, Loreta Bagdonaitė^{9

10}, Dalius Vitkus^{9

10}, Mindaugas Balčiūnas^{1

3}, Gitana Zuozienė^{1

3}, Jūratė Barysienė^{1

3}, Diana Žaliaduonytė¹¹, Kęstutis Stašaitis¹², Aušra Kavoliūnienė¹¹, Alexandre Mebazaa^#^{5

6

13}, Jelena Čelutkienė^#^{14

15}

Affiliations

¹ Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
² Centre of Emergency Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
³ Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
⁴ Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands.
⁵ Department of Anesthesiology and Critical Care, Assistance Publique des Hopitaux de Paris, Paris, France.
⁶ Cardiovascular Markers in Stress Conditions (MASCOT), Inserm UMR-S 942, Paris, France.
⁷ Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland.
⁸ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
⁹ Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹⁰ Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
¹¹ Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
¹² Department of Emergency Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
¹³ Université de Paris, Paris, France.
¹⁴ Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania jelena.celutkiene@santa.lt.
¹⁵ Centre for Innovative Medicine, State Research Institute, Vilnius, Lithuania.

^# Contributed equally.

Abstract

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.

Keywords: Adult cardiology; Echocardiography; Heart failure; Ultrasound; VASCULAR MEDICINE.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Biomarkers
CD146 Antigen
Dyspnea / diagnosis
Echocardiography*
Heart Failure*
Humans
Lithuania
Natriuretic Peptide, Brain
Peptide Fragments
Prospective Studies

Substances

CD146 Antigen
Natriuretic Peptide, Brain
Biomarkers
Peptide Fragments