Left ventricular remodeling and fibrosis indices are strongly associated with soluble ST2 but not with NTproBNP in patients with HFrEF: a comparative analysis
A Ntalianis, K Bratis, G Velissaris, M Pentaris, I Tsallos, V Stavropoulou, S Mykoniati, Z Morou, E Panagiotopoulos, N Biagkis, M Zagkli, S Chatzidou, N Papaioannou, S Papaioannou, D ChatzisAbstract
Background
NTproBNP associates with left ventricular diastolic strain and myocardial wall stress and it is considered a landmark biomarker for diagnosis, prognosis, risk stratification and decision making in patients with HFrEF. In contrast, soluble ST2 a decoy for interleukin -33, can theoretically reflect the extent of myocardial fibrosis and remodeling process.
Purpose
To investigate the association of NTproBNP and soluble ST2 with remodeling and fibrosis indices determined from cardiac magnetic resonance imaging (MRI) in patients with HFrEF.
Methods
Thirty two symptomatic patients with HFrEF (NYHA≥2), despite maximally tolerated guideline-directed medical therapy were prospectively recruited. All patients were submitted to stress cardiac MRI and at the same time venous blood was collected and sent for NTproBNP and soluble ST2 analysis. Left ventricular mass (LVM) and compliance (LVC), end diastolic (LVEDV), end systolic (LVESV) and stroke volume (SV), ejection fraction (LVEF), global longitudinal strain (GLS), remodeling and sphericity index assessed by cardiac MRI were considered as remodeling indices and T1 mapping was implemented to characterize the extent of myocardial fibrosis. The left ventricular compliance (LVC) was derived from the formula: LVC=0.9 x Systolic arterial pressure / LVESV.
Results
The mean LVEF, LVEDV, LVESV and GLS were 27±10%, 231±56 ml, 171±28 ml and -8.57±2.34% respectively. An inverse association between soluble ST2 and LVEF, SV and LVC and positive correlation with LVM and T1 mapping was observed (table). Conversely, NTproBNP was only inversely associated with the left atrial ejection fraction (table).
Conclusions
Soluble ST2 is a more accurate marker of left ventricular remodeling and the extent of myocardial fibrosis as compared to NTproBNP in patients with HFrEF.For image description, please refer to the figure legend and surrounding text.