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Angiopoietin-2 and outcome in patients with acute decompensated heart failure

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Abstract

Purpose

Angiopoietin-2 (Ang-2) impairs endothelial integrity. The association of Ang-2 in the presence of oedema and outcome of patients with acute decompensated heart failure (ADHF) has not been investigated.

Methods and results

Angiopoietin-2 was measured in 132 ADHF patients, which were included in a monocentric, prospective trial (Clinicaltrials.gov: NCT01429857). Primary endpoint was all-cause death at 6-months. 20 healthy persons served as control group (HC). In ADHF patients, mean Ang-2 concentration at admission was significantly increased compared to HC (2,111 ± 117 vs. 971 ± 46 pg/ml, p = 0.0002). Ang-2 was increased in patients with compared to those without peripheral oedema (2,294 ± 140 vs. 1,540 ± 170 pg/ml; p = 0.009) and in patients with NYHA class III or IV symptoms compared to those with NYHA class II symptoms (2,256 ± 132 vs. 1,341 ± 380 pg/ml, p = 0.023). During the 6-month follow-up, 10 patients died. In survivors, Ang-2 significantly decreased at discharge compared to admission (2,046 ± 118 vs. 1,431 ± 93 pg/ml; p < 0.0001). Non-survivors showed no difference between Ang-2 concentration at admission and discharge (3,296 ± 594 vs. 2,909 ± 536 pg/ml). Ang-2 concentrations at discharge above 2,500 pg/ml were associated with an increased risk of death compared to Ang-2 concentrations below this threshold (Hazard ratio 8.8; 95 % confidence interval; 2.48–31.16, p < 0.001).

Conclusion

In ADHF patients, Ang-2 is significantly increased compared to healthy controls, shows a relationship in the presence of oedema and is a predictor of poor outcome.

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Acknowledgements

We thank Nina Rebmann for excellent technical assistance.

Conflict of interest

JP, CU, PE, GF, SE, MB, AL have no conflicts of interest to declare. IK received speaker’s honoraria from Vifor Pharma, Boehringer Ingelheim and Novartis. FM is supported by Deutsche Hochdruckliga and Deutsche Gesellschaft für Kardiologie.

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Author notes

  1. Janine Pöss

    Present address: Klinik für Innere Medizin 2, UKSH - Campus Lübeck, Ratzburger Allee 160, 23538, Lübeck, Germany

Authors and Affiliations

  1. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany

    Janine Pöss, Christian Ukena, Ingrid Kindermann, Peter Ehrlich, Sebastian Ewen, Felix Mahfoud, Steffen Kriechbaum, Michael Böhm & Andreas Link

  2. University of Leipzig, Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany

    Georg Fuernau

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  1. Janine Pöss
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Correspondence to Janine Pöss.

Additional information

J. Pöss and C. Ukena contributed equally to this manuscript.

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Pöss, J., Ukena, C., Kindermann, I. et al. Angiopoietin-2 and outcome in patients with acute decompensated heart failure. Clin Res Cardiol 104, 380–387 (2015). https://doi.org/10.1007/s00392-014-0787-y

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