Abstract 13089: Serum Soluble ST2 as a Biomarker for Detecting Heart Failure with a Normal Ejection Fraction in Hypertensive Patients
Background. Serum soluble ST2 is a novel diagnostic and prognostic marker for patients (pts) with heart failure (HF) and left ventricular (LV) systolic dysfunction. However, its application to HF with a normal LV ejection fraction (LVEF) (HFNEF) remains less studied.
Method. Echocardiography, serum NT-proBNP and ST2 concentration were evaluated in 107 hypertensive pts (65±12 years, 57 male) with EF >50 %, serum creatinine <1.4 mg/dl and without significant valvular heart disease or active ischemia. Among them, 68 pts with HF signs/symptoms and mitral E/Ea (annular early diastolic velocity) > 8 were the HFNEF group, and the other 39 pts were as the control (Ctrl).
Result. When compared to the Ctrl, pts with HFNEF were older (68±10 vs. 60±12 years, P <0.001), more female (54 vs. 33 %, P=0.036), and had greater left atrial diameter (38±5 vs. 35±6 mm, P=0.043), greater LV wall thickness, and more severe diastolic abnormality as expected. The serum level of NT-proBNP (262±470 vs. 71±53 pg/ml, p=0.025) and ST2 (18±8 vs. 12±5 ng/ml, p<0.001) were also higher in pts with HFNEF than in Ctrl. The area under the receiver-operating characteristic curve for ST2 was 0.80 (95 % CI, 0.70 to 0.89, P<0.001), better than that for NT-proBNP (area under the curve, 0.70; 95 % CI, 0.58 to 0.79, P<0.003) to detect HFNEF (figure). However, the NT-proBNP concentration increased much more significantly when the mitral E/Ea elevated (E/Ea >15: 650±874 vs. E/Ea 8-15: 163±214 pg/ml, p<0.001), but the serum ST2 remained unchanged even with a higher mitral E/Ea (E/Ea >15: 18±8 vs. E/Ea 8-15: 18±6 ng/ml, p=ns). After multivariate adjustment, the ST2 >13.5 ng/ml was independently associated with HFNEF in hypertensive pts (hazard ratio=2.5, 95 % CI=1.8-4.4; p<0.001).
Conclusion. The data suggested serum ST2 measurement could serve as an independent biomarker for diagnostic aid of HFNEF in hypertensive pts. Addition of NT-proBNP to ST2 could provide more information regarding the severity of LV diastolic impairment.
- © 2011 by American Heart Association, Inc.