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)?


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).


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.


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.


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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