Insulin-like Growth Factor Binding Protein 2 in Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Gender-Based Perspective

Abstract Background Severe aortic valve stenosis (AS) and pulmonary hypertension (PH) are life-threatening cardiovascular conditions, necessitating early detection and intervention. Recent studies have explored the role of Insulin-like Growth Factor Binding Protein 2 (IGF-BP2) in cardiovascular pathophysiology. Understanding its involvement may offer novel insights into disease mechanisms and therapeutic targets for these conditions. Material & Methods 102 patients (46 female, 56 male) with severe AS undergoing transcatheter aortic valve replacement (TAVR) in a single-center study were classified using echocardiography to determine systolic pulmonary artery pressure (sPAP) and the presence (sPAP ≥ 40 mmHg) or absence (sPAP < 40 mmHg) of PH. Additionally, serial laboratory determinations of IGF-BP2 before, and at 24 hours, 96 hours, and 3 months after intervention were conducted in all study participants. Results & Discussion Considering the entire cohort, patients with PH had significant and continuously higher serum IGF-BP2 concentrations over time than the cohort without PH. After subdivision by sex, it could be demonstrated that above-mentioned results were only verifiable in male, but not in female sex. In the male sex, baseline IGF-BP2 before TAVR was an isolated risk factor for premature death after intervention and at 1, 3 and 5 years post intervention. The same was valid for the combination of male sex and echocardiographically established PH. Conclusion The predictive role of IGF-BP2 in severe AS and concurrent PH remains unknown. A more profound comprehension of IGF-BP2 mechanisms, particularly in males, could facilitate earlier consideration of TAVR as a more effective and successful treatment strategy.