title: Endogenous Ouabain: An Old Cardiotonic Steroid as a New Biomarker of Heart Failure and a Predictor of Mortality after Cardiac Surgery.
abstract: Cardiovascular diseases remain the main cause of mortality and morbidity worldwide; primary prevention is a priority for physicians. Biomarkers are useful tools able to identify high-risk individuals, guide treatments, and determine prognosis. Our aim is to investigate Endogenous Ouabain (EO), an adrenal stress hormone with hemodynamic effects, as a valuable biomarker of heart failure. In a population of 845 patients undergoing elective cardiac surgery, we have investigated the relationships between EO and echocardiography parameters/plasmatic biomarker of cardiac function. EO was found to be correlated negatively with left ventricular EF (p = 0.001), positively with Cardiac End-Diastolic Diameter (p = 0.047), and positively with plasmatic NT-proBNP level (p = 0.02). Moreover, a different plasmatic EO level (both preoperative and postoperative) was found according to NYHA class (p = 0.013). All these results have been replicated on an independent cohort of patients (147 subjects from US). Finally, a higher EO level in the immediate postoperative time was indicative of a more severe cardiological condition and it was associated with increased perioperative mortality risk (p = 0.023 for 30-day morality). Our data suggest that preoperative and postoperative plasmatic EO level identifies patients with a more severe cardiovascular presentation at baseline. These patients have a higher risk of morbidity and mortality after cardiac surgery.
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Simonini
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Pozzoli
authors.affiliation: Anesthesia and Intensive Care Department, "Vita-Salute" San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Nunzia
authors.initials: N
authors.lastname: Casamassima
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Messaggio
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lanzani
authors.affiliation: Anesthesia and Intensive Care Department, "Vita-Salute" San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Frati
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Irene Maria
authors.initials: IM
authors.lastname: Botticelli
authors.affiliation: SUNY Downstate Medical Center, State University of New York, Brooklyn, NY 11203, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rotatori
authors.affiliation: Cardiac Surgery Department, "Vita-Salute" San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Anesthesia and Intensive Care Department, "Vita-Salute" San Raffaele University, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: Genomics of Renal Diseases and Hypertension Department, "Vita-Salute" San Raffaele University, Chair of Nephrology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Manunta
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D002316:Cardiotonic Agents / Q000378:metabolism*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010042:Ouabain / Q000378:metabolism*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013256:Steroids / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D013256:Steroids; D010042:Ouabain