Changes in NT-proBNP and sST2 concentrations after decompensated heart failure and long-term prognosis of patients with CHF and reduced LVEF

Background. To reduce the risk of cardiovascular events within a year in patients with chronic heart failure with reduced ejection fraction (CHFrEF) and hospitalized due to acute decompensated heart failure, it is necessary to achieve simultaneous reduction of sST2≤23.4 ng/ml or by ≥34.3% and NT-proBNP ≤1132 pg/ml and by ≥38.9% within 6 months after discharge. Objective. To evaluate significance of these indicators for determining the five-year prognosis of patients with HFrEF after acute decompensation of heart failure. Material and methods. The study included 130 patients hospitalized for decompensated HFrEF due to coronary artery disease, dilated cardiomyopathy, and arterial hypertension. Concentrations of sST2 and NT-proBNP were determined at baseline, upon discharge, and after 180 days. The follow-up period was 5 years (median 43, range 16-61). A combined endpoint (CEP) was used to assess the prognosis (all-cause mortality and heart transplantation). Results. CEP was reached by 55 patients. The highest prognostic value was observed for achievement of threshold value rather degree of biomarker decrease: for NT-proBNP <1132 pg/ml and for sST2 <23.4 ng/ml after 6-month outpatient treatment. Patients with both indicators had minimal risk of CEP. The maximum risk of CEP was in patients without both values (HR=6.507; 95% CI 2.679—15.808, p<0.001; for NT-proBNP alone HR=5.098; 95% CI 1.992—13.050, p<0.001l for sST2 alone HR=4.259; 95% CI 1.372—13.217, p<0.012). Conclusion. To improve the five-year prognosis in patients with HFrEF and previous decompensation, it is necessary to achieve simultaneous decrease of sST2<23.4 ng/ml and NT-proBNP<1132 pg/ml within 6 months.