Prognostic value of soluble ST2 and NT-proBNP in symptomatic patients with heart failure and reduced ejection fraction
A Ntalianis, D Chatzis, S Mykoniati, Z Morou, C Kourek, O Simou, I Dena, M Pentaris, E Panagiotopoulos, N Papaioannou, K Bratis, N Biagkis, S Papaioannou, D Delialis, G VelissarisAbstract
Background
The prognostic value of NTproBNP in patients with HFrEF has been already established. However, there is still conflicting data regarding the prognostic value of soluble ST2, a biomarker of myocardial fibrosis and remodeling which theoretically may add significant prognostic information in patients with HFrEF.
Purpose
We aimed at investigating the value of soluble ST2 as compared to NTproBNP for risk stratification of patients with HFrEF.
Methods
Consecutive symptomatic patients with HFrEF on maximum tolerated GDMT were prospectively included. All patients were submitted to cardiac magnetic resonance imaging before the recruitment. Furthermore, peripheral venous blood samples were taken to define NTproBNP and soluble ST2 levels. One year mortality and heart failure hospitalizations were considered the end-points of the study.
Results
In total, 40 patients with HFrEF (median age: 69.4 y, mean ejection fraction: 29±5%, ΝΥΗΑ: 2.8±0.8, mean soluble ST2: 13,3±10 ng/ml, mean NTproBNP: 2447±895 ng/ml) were studied. A higher left ventricular end diastolic and end systolic volume, lower left ventricular ejection fraction and higher right ventricular end systolic volume was observed in the deceased patients (Figure 1). Both soluble ST2 (cut-off values> 35 ng/ml) and NTproBNP (cut-off values> 900 ng/ml) were able to discriminate the survivors from the deceased patients (Figure 2). NTproBNP was a better survival predictor as compared to soluble ST2.
Conclusions
The soluble ST2 is a reliable biomarker for risk stratification of patients with HFrEF. Further data are warranted regarding its additive to NTproBNP prognostic value.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.