To the editor
In addition to the renin-angiotensin-aldosterone system and the sympathetic nerve system, the arginine vasopressin system is receiving great concern as a therapeutic target in patients with cardiovascular disease. Fujii and colleagues demonstrated that both plasma arginine vasopressin and urine aquaporin-2 levels were elevated immediately after the surgical aortic valve replacement . Both variables had a positive correlation with each other. They hypothesized that a urine aquaporin-2 level might be a potential biomarker of perioperative cardiac dysfunction. Several concerns should improve the implication of their findings.
Our team previously demonstrated that a reduced excretion of urine aquaporin-2 relative to plasma arginine vasopressin level might indicate impairment of kidney collecting duct . Urine aquaporin-2 level may not be a good tool to assess cardiac function in patients with advanced chronic kidney disease, although such patients were not included in their study .
Second, our team could not demonstrate the implication of peri-procedural plasma arginine vasopressin level on clinical outcomes following trans-catheter aortic valve replacement, probably due to relatively maintained peri-procedural hemodynamics in most patients . Urine aquaporin-2 level might be useful particularly for the patients with relatively deteriorated hemodynamics including low-flow low-gradient aortic valve stenosis or decompensated heart failure.
Fujii M, Amitani R, Bessho R (2020) Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery. Heart Vessels 35:712–728
Imamura T, Kinugawa K, Fujino T, Inaba T, Maki H, Hatano M, Yao A, Komuro I (2014) Increased urine aquaporin-2 relative to plasma arginine vasopressin is a novel marker of response to tolvaptan in patients with decompensated heart failure. Circ J 78:2240–2249
Kuwahara H, Imamura T, Sobajima M, Ueno H, Kinugawa K (2020) Regulation and clinical implication of arginine vasopressin in patients with severe aortic stenosis referred to trans-catheter aortic valve implantation. Medicina (Kaunas) 56:E165
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Imamura, T. Implication of urine aquaporin-2 levels following cardiac surgery. Heart Vessels (2020). https://doi.org/10.1007/s00380-020-01661-6
- Heart failure
- Aortic stenosis
- Aortic valve replacement