New perspectives in the renin-angiotensin-aldosterone system (RAAS) IV: circulating ACE2 as a biomarker of systolic dysfunction in human hypertension and heart failure

• Published in: PloS one 2014-04, Vol.9 (4), p.e87845-e87845
• Main Authors: Úri, Katalin, Fagyas, Miklós, Mányiné Siket, Ivetta, Kertész, Attila, Csanádi, Zoltán, Sándorfi, Gábor, Clemens, Marcell, Fedor, Roland, Papp, Zoltán, Édes, István, Tóth, Attila, Lizanecz, Erzsébet
• Format: Article
• Language: English
• Subjects: ACE inhibitors; ACE2; Adult; Aldosterone; Angiotensin; Angiotensin-converting enzyme 2; Biology and Life Sciences; Biomarkers; Biomarkers - blood; Blood pressure; Cardiology; Cardiovascular diseases; Complications and side effects; Converting; Correlation analysis; Disease; Dosage and administration; Drug therapy; Enzymes; Female; Gene expression; Genetic aspects; Heart; Heart diseases; Heart failure; Heart Failure - blood; Heart Failure - diagnostic imaging; Heart Failure - enzymology; Heart Failure - physiopathology; Humans; Hypertension; Hypertension - blood; Hypertension - diagnostic imaging; Hypertension - enzymology; Hypertension - physiopathology; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Middle Aged; Natriuretic Peptide, Brain - metabolism; Patients; Peptide Fragments - metabolism; Peptidyl-dipeptidase A; Peptidyl-Dipeptidase A - blood; Physiological aspects; Physiology; Populations; Remodeling; Renin; Renin-Angiotensin System; Research and Analysis Methods; Science; Stroke Volume; Systole; Ultrasonography; Ventricle; Ventricular Remodeling
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087845

Growing evidence exists for soluble Angiotensin Converting Enzyme-2 (sACE2) as a biomarker in definitive heart failure (HF), but there is little information about changes in sACE2 activity in hypertension with imminent heart failure and in reverse remodeling. Patients with systolic HF (NYHAII-IV, enrolled for cardiac resynchronisation therapy, CRT, n = 100) were compared to hypertensive patients (n = 239) and to a healthy cohort (n = 45) with preserved ejection fraction (EF>50%) in a single center prospective clinical study. The status of the heart failure patients were checked before and after CRT. Biochemical (ACE and sACE2 activity, ACE concentration) and echocardiographic parameters (EF, left ventricular end-diastolic (EDD) and end-systolic diameter (ESD) and dP/dt) were measured. sACE2 activity negatively correlated with EF and positively with ESD and EDD in all patient's populations, while it was independent in the healthy cohort. sACE2 activity was already increased in the hypertensive group, where signs for imminent heart failure (slightly decreased EF and barely increased NT-proBNP levels) were detected. sACE2 activities further increased in patients with definitive heart failure (EF