Vascular Endothelial Growth Factor C: a novel potential biomarker for peripheral tissue congestion in acute heart failure

Patients with acute heart failure and low concentrations of vascular endothelial growth factor C (VEGF-C) on admission show a higher mortality after a year compared to those with higher VEGF-C concentrations. Due to its association with factors for cellular adhesion, VEGF-C may be used as an indicator of peripheral congestion.

Patients presenting with severe signs of peripheral congestion from acute heart failure have a worse prognosis in terms of one-year mortality and the composite endpoint of one year mortality or heart failure re-hospitalisation. Therefore, serological markers for tissue congestion would assist in helping make clinical decisions and assessing the prognosis of patients suffering from acute heart failure. Dr Gracjan Iwanek (Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland) measured VEGF-C serum levels on admission and at discharge in 237 patients hospitalized for acute heart failure and assessed their influence on prognosis. He then stratified the study population into the following VEGF-C tertiles: low (33 pg/ml), medium (606 pg/ml), and high (1141 pg/ml).

The low VEGF-C group on admission showed a significant increase in serum levels during hospitalization (from 33 [95% CI 15-175] pg/ml to 465 [95% CI 327-648] pg/ml, p<0.001), whereas the medium VEGF-C did not change during the hospital stay. In contrast, there was a significant drop in serum VEGF-C levels in the high VEGF-C group (from 1141 [95% CI 967-1443] to 704 [95% CI 477-1009] pg/ml, p<0.001). Therefore, VEGF-C serum levels from different tertiles on admission shifted in a common direction.

The one-year mortality was highest in the low VEGF-C tertile and lower in the other 2 tertiles (35% vs 28% in the medium tertile and 18% in the highest tertile; P = 0.048). The same pattern was observed for a composite endpoint of death and acute heart failure re-hospitalisation. The corresponding numbers were here 45% in the lowest tertile compared to 43% and 26% in the highest tertile (p = 0.012).

To shed light on the pathophysiology behind the VEGF-C release, Dr Iwanek also assessed different cardiovascular biomarkers and molecules responsible for cellular adhesion.

VEGF concentrations showed no association with NT-proBNP, Creatinine, and troponin but to molecules responsible for cellular adhesion (like galectin-3, selectin, and ICAM-1) and communication.

These results further hint to the relationship of VEGF-C with peripheral tissue congestion. Therefore, its use as an indicator of peripheral congestion may be justified.

Source:

1. Iwanek G et al, Vascular endothelial growth factor C as a potential biomarker of peripheral tissue congestion in acute heart failure. Session E-posters in acute heart failure, Heart Failure 2023, 20–23 May, Prague, Czechia.

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Posted on 23 May, 202323 May, 2023