Implication of urine aquaporin-2 levels following cardiac surgery

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 [1]. 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 [2]. 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 [1].

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 [3]. 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.

References

  1. 1.

    Fujii M, Amitani R, Bessho R (2020) Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery. Heart Vessels 35:712–728

    Article  Google Scholar 

  2. 2.

    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

    CAS  Article  Google Scholar 

  3. 3.

    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

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Teruhiko Imamura.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Imamura, T. Implication of urine aquaporin-2 levels following cardiac surgery. Heart Vessels (2020). https://doi.org/10.1007/s00380-020-01661-6

Download citation

Keywords

  • Heart failure
  • Aortic stenosis
  • Aortic valve replacement
  • Vasopressin