Elevated serum osteoprotegerin is associated with increased left ventricular mass index and myocardial stiffness

Abstract

Aim: Osteoprotegerin (OPG) is associated with a poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). OPG has also been associated with fibrosis and collagen cross-linking, which increase arterial and left ventricle (LV) myocardial stiffness. Little is known about the relation of OPG and LV structure and function in African-Americans who are disproportionately affected by HFpEF.

Methods and results: Our analysis included 1172 participants with preserved LV ejection fraction (>50%) from the African-American cohort in the Genetic Epidemiology Network of Arteriopathy Study (mean age 63 years, 72% female). We used diastolic wall strain indicator measured by echocardiography to assess LV myocardial stiffness. Diastolic wall strain was calculated as (LV posterior thickness at end-systole - LV posterior thickness at end-diastole)/LV posterior thickness at end-systole. Associations between OPG levels and indices of arterial and LV structure and function were evaluated by using generalized linear mixed models and adjusted for possible confounders. OPG levels were correlated with age, female sex, presence of hypertension and diabetes, and lower estimated glomerular filtration rate (P < 0.05 for all). Multivariable analysis revealed that higher OPG levels were associated with greater LV mass index, increased LV myocardial stiffness, and higher N-terminal prohormone brain natriuretic peptide levels (P < 0.05 for all).

Conclusion: In African-Americans, higher OPG levels were associated with characteristics common in patients with HFpEF and were significantly associated with known precursors to HFpEF. These findings indicate a potential role for OPG in the pathophysiology of HFpEF in African-Americans.

Fig. 1

Unadjusted correlation between osteoprotegerin concentrations and left ventricle mass index (a), and diastolic wall strain (b). Left ventricle mass index demonstrated a weak but significant positive correlation with osteoprotegerin, while diastolic wall strain demonstrated a weak and negative correlation with osteoprotegerin. DWS, diastolic wall strain; OPG, osteoprotegerin.

Fig 2

Adjusted correlation between osteoprotegerin concentrations and N-terminal prohormone brain natriuretic peptide concentrations. Marginal effect of osteoprotegerin concentration levels on N-terminal prohormone brain natriuretic peptide concentration levels with a point-wise 95% confidence interval, from a linear regression Model 2. BNP, brain natriuretic peptide; OPG, osteoprotegerin.