Abstract 10981: ST2 and NT-proBNP are Associated with Cardiac Dysfunction and Mortality in HIV-Infected Individuals
Background: ST2, of the IL-1 receptor superfamily, and NT-proBNP are upregulated during cardiomyocyte strain and predict cardiac disease. We studied whether ST2 and NT-proBNP are associated with cardiac dysfunction and mortality in ambulatory HIV patients.
Methods: ST2, NT-proBNP and echocardiograms were assessed in 332 HIV patients and 50 controls between 2004-2010. We defined systolic dysfunction as ejection fraction <50% and diastolic dysfunction as ≥ stage 1. Mortality data was obtained through the National Death Index.
Results: HIV patients had a median age of 49 years, 80% were male, 34% had hypertension, 59% had dyslipidemia and 35% used tobacco. Compared with controls, HIV infection was associated with both higher ST2 (+3.0 ng/ml, 95%CI 0.034-6.0; p = 0.047) and NT-proBNP (+11.7 pg/mL, 95%CI 2.9-20.5, p=0.0094). Among HIV patients, elevated ST2 was associated with diastolic dysfunction (Prevalence Ratio (PR)=1.41 per doubling, 95%CI 1.05-1.89, p=0.023), while NT-proBNP was not (p=0.77). The prevalence of diastolic dysfunction increased with ST2 tertiles (trend p=0.0074). In addition, increased NT-proBNP was marginally associated with systolic dysfunction (PR per doubling = 1.18, p=0.14), while ST2 was not (p=0.40). Twenty-five HIV deaths occurred over a median 5.7 years of follow-up. Mortality was associated with both elevated ST2 (HR 1.81 per doubling, p=0.10) and NT-proBNP (HR 1.26 per doubling, p=0.0088). Using ROC analyses, thresholds exceeding ST2 >39 ng/ml or NT-proBNP >128.2 pg/ml predicted mortality (HR 2.48, 95%CI 1.05-5.84, p=0.038 and HR 2.86, 95%CI 1.27-7.17, p=0.026) (Figure), but in combination, did not strengthen the prediction of mortality.
Conclusion: Among ambulatory HIV patients, both ST2 and NT-proBNP were higher compared to controls and associated with mortality. In contrast to NT-proBNP, ST2 was associated with diastolic dysfunction. ST2 and NT-proBNP may be useful biomarkers of CV outcomes and mortality in HIV infection.
- © 2012 by American Heart Association, Inc.