Biomarkers of myocardial stress and fibrosis for clinical outcomes assessment in post myocardial infarction heart failure patients

Abstract

Aim. To assess the prognostic significance of the ST2 and N-terminal pre-brain natriuretic peptide (NT-proBNP) in patients with chronic heart failure (CHF) of ischemic origin. Material and methods. The study included 127 patients with CHF, post myocardial infarction (age median 57 y. o., left ventricle ejection fraction - 54%), consequently admitted at Clinic. The biomarker concentrations representing myocardial stress (NT-proBNP) and fibrosis with remodeling of the ventricles (ST2) were measured with the immune enzyme assay. Endpoint was all-cause mortality and repeat hospitalizations during 9-month follow-up. Results. Levels of ST2 and NT-proBNP were higher in adverse outcome patients (n=19) comparing to the patients with no repeat cardiovascular events (р=0,004 and 0,001, respectively). Receiver operating characteristic (ROC) analysis for outcomes prediction defined the optimal threshold values of 43,6 ng/mL for ST2 and 285 pg/mL for NT-proBNP. In comparison of ROC-curves, biomarkers had comparable areas under the curves (p=0,659). In binary regression model, statistically significant predictors for combination endpoint were ST2, NT-proBNP and traditional risk factors (class by New York Heart Association, left ventricle aneurysm, stroke anamnesis, estimated glomerular filtration rate <90 mL/min/1,73 m2). The model had the under-curve-area 0,900 (p<0,001). Conclusion. ST2 and NT-proBNP are significant predictors of adverse clinical outcomes in CHF patients post myocardial infarction.