Endogenous Ouabain: An Old Cardiotonic Steroid as a New Biomarker of Heart Failure and a Predictor of Mortality after Cardiac Surgery

Abstract EN

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.