Serum Level Of Endostatin Correlates With Pulmonary Arterial Pressure In Patients With Congenital Heart Disease

Objective:To investigate the correlation between serum level of endostatin and pulmonary arterial pressure in patients with congenital heart disease.Methods:Serum samples were obtained from 68 cases with congenital heart disease and 20 cases with supraventricular tachycardia (SVT) who were enrolled in the 2nd XiangYa hospital from February,2009 to March,2010. All patients with congenital heart disease were received right heart catheterization. The subjects were divided into three groups: control group(SVT group), non-pulmonary hypertension group(sPAP<30 mmHg) and pulmonary hypertension group(sPAP≥30mmHg) according to pulmonary artery systolic pressure measured by right heart catheterization. Moreover, pulmonary hypertension group were divided into three sub-groups:mild pulmonary hypertension group (30mmHg≤sPAP< 50mmHg), moderate pulmonary hypertension group (50mmHg≤sPAP< 70mmHg), severe pulmonary hypertension group (sPAP≥70mmHg). ES concentration was determined by enzyme linked immune sorbent assay (ELISA). The correlations between ES and other parameters(sPAP, dPAP, mPAP, etc) were compared. The area under the Receiver Operating Characteristic curve(AUCR0C) were used for evaluating the reliability of ES,TPR, Qp/Qs and sPAPusc to forecast the outcome of oxygen inhalation test as predictors.Results:1. There was no significant difference in gender, ages, heights, weights, hemoglobin and serum creatinine between control group, non-pulmonary hypertension group and pulmonary hypertension group.2. There was no significant difference between ES measured from the pulmonary artery and that measured from the left ventricle (p= 0.588). And there was no significant difference in ES between ASD group, VSD group and PDA group (p= 0.32).3. There was no significant difference in ES between SVT group and non-pulmonary hypertension group (p= 0.717). ES concentration in PHT group is significantly lower than that of the non-PHT group(p=0.001) and SVT group(p=0.004). There was significant difference in ES among the three sub-groups of PHT patients (p<0.01). Along with an increase in sPAP, the concentration of ES decreased.4. In the univariable models, ES positively correlated with Qp, Qp/Qs and blood oxygen saturation of pulmonary artery, and ES negatively correlated with age, Qs, sPAP, dPAP, mPAP, TPR, FLV and RVT/LVT. In the multiple stepwise regression model, only TPR remained as an independent predictor of ES level (r=-0.875, p<0.01).5. When ES,TPR, Qp/Qs and sPAPusc were used to predict the outcome of oxygen inhalation test as predictors, ES and TPR was statistically significant (P=0.02). Cutoff points of 210.7pg/ml and 11.7wood in ES and TPR were respectively with sensitivity of 90.7% and 90.9%, specificity of 75% and 75%, and Youden's index of 0.657 and 0.659. The AUCROC for ES and TPR were respectively 0.841 and 0.845, which were the better among the above four parameters.Conclusion:1. Along with an increase in sPAP, the concentration of ES decreased and negatively correlated with sPAP. As a inhibitory factor, ES played a important role in the development of PHT, and might be involved in protective mechanism against further increase of pulmonary arterial pressure.2. TPR remained as an independent predictor of ES level.3. The combination ES concentration with echocardiography may be the key of the correct selection of operative indication,but also be the key of judging whether pulmonary hypertension secondary to left-to-right shunt or pulmonary resistance hypertension.4. Using recombinant ES might be a new way to delay the progress of PHT.