Relationship between blood pressure response and microRNAs 1, 133a, 206, 202-3p after transcatheter aortic valve implantation and its impact on myocardial strain parameters

Background: After successful Transcatheter Aortic Valve Implantation (TAVI) we expect an improvement in myocardial global strain, which should be causally linked to blood pressure rise, both affecting patient survival and quality of life. Despite release of left ventricular (LV) pressure overload by TAVI, some patients fail to derive a functional, morbidity or mortality benefit in the post-procedural period. Circulating microRNAs are emerging as a novel class of biomarkers, that can be secreted by cells within exosomal particles. Previous studies have demonstrated that the circulating levels of specific miRNAs are associated to LV remodelling and to changes in shear stress across the aortic valve. This study aims to assess variations in exosomal mir-206 in patients with severe aortic stenosis after correction by means of TAVI and to find determinants of poor prognosis, linked to blood pressure- and myocardial strain- development. Methods: Serum from 45 patients with aortic valve disease undergoing TAVI was obtained at 3 different time points: Pre TAVI, post-TAVI at the day of discharge and after a period of 3 months. We isolated exosomes and next performed quantitative real-time PCR in order to examine the samples for changes in the level of mir-1,133a, 206 and 202-3p. Echocardiography with determination of global longitudinal strain (GLS) was performed concomitantly at three time points as indicated. Blood pressure development was recorded and quantified using a 24h ambulatory system for all three time points. Results: The post-procedural decrease of miR-206 and gain of GLS after TAVI showed a negative correlation. In line with this, the less the miR decrease the higher the absolute strain value post TAVI. Moreover, the chisquare test indicated that patients with a further decrease of miR-206 between discharge and 3 months displayed significant less gain in GLS at three months. Additionally, there was a negative correlation between miR-206 decrease directly after the procedure and gain of mean arterial pressure (MAP) as well as diastolic blood pressure (DBP) at 3 months. The chisquare test indicated that patients with post-procedural decrease of mir-206 displayed significant less gain in GLS at three months. Concomitantly MAP increase was lower in patients with significant decrease of mir-206 post-TAVI. Patients with major cardio- and cerebrovascular events (MACCEs) displayed significant decrease of miR-206 compared to patients without MACCEs. Moreover patients with a not-improved NYHA class (NYHA>> 2) showed significant decrease of miR-206 compared to patients with an improved/stable functional status. Conclusion: MiR-206 decrease post-TAVI is linked to cardiac function and blood pressure development and may predict clinical outcome at short term follow up. Keywords: Mir 206, global longitudinal strain, TAVI, blood pressure, heart failure