Circulating Angiopoietins and Cardiovascular Mortality in Cardiogenic Shock

Study Questions:

What is the relationship between circulating levels of angiopoietins (Ang) (1 and 2) and mortality in patients with cardiogenic shock (CS)?

Methods:

Plasma levels of Ang-1 and Ang-2 were measured in 96 patients with CS, 20 patients with uncomplicated acute myocardial infarction, and 20 age-matched healthy controls (HC).

Results:

Ang-2 was threefold elevated in CS compared with HC (p < 0.001), remained elevated in nonsurvivors, and decreased in survivors (p < 0.001). In contrast, Ang-1 decreased up to 35-fold in CS (p < 0.001). Ang-1 was correlated and Ang-2 was inversely related to a cardiac power index and mixed venous oxygen saturation, respectively (p < 0.001 for all). For Ang-2 at admission, a cut-off point of 2500 pg/ml had a sensitivity of 61% and a specificity of 80% for 28-day mortality in CS. Ang-2 levels >2500 pg/ml at admission were also observed to be an independent predictor for 1-year mortality in CS.

Conclusions:

Circulating Angs are closely related to outcome and severity in CS. Ang-2 emerged as an independent predictor of 28-day and 1-year mortality in CS. Angs may be prognostic biomarkers for survival in CS and might represent novel therapeutic targets.

Perspective:

Angs are regulators of vascular integrity and may play causal roles in critical illnesses involving hemodynamic compromise. Ang-1 binds to the endothelial Tie-2 receptor, where it promotes vascular integrity and suppresses inflammatory cytokine expression, whereas Ang-2 results in impaired endothelial integrity due to inhibition of Ang-1 binding to Tie-2. This study characterized the patterns of Angs in patients with CS and supports a possible role for elevated Ang-2 as a prognostic biomarker in patients with CS. The causal role of these proteins in CS outcomes will require further study.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Proteins, Myocardial Infarction, Oximetry, Cytokines, Sensitivity and Specificity, Angioplasty, Balloon, Coronary, Hemodynamics, Heart Diseases, Shock, Cardiogenic, Prognosis, Receptor, TIE-2, Biological Markers, Heart Failure, Angiopoietins, Critical Illness, Organosilicon Compounds, Oxygen


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