Soluble ST2 as a Potential Biomarker for Risk Assessment of Pulmonary Hypertension in Patients Undergoing TAVR?

Figure 1. Patient disposition in study cohort. AS: aortic stenosis; TAVR: transcatheter aortic valve replacement; sST2: soluble suppression of tumorigenicity 2; mPAP: mean pulmonary arterial pressure; PH: pulmonary hypertension; PAWP: pulmonary capillary wedge pressure.

Figure 2. Results of sST2 analysis in dependence of PH presence or PH absence No PH vs. prec-PH: p = 0.918 No PH vs. post-PH: p = 0.003 (* p ≤ 0.050) Prec-PH vs. postc-PH: p = 0.109. sST2: soluble suppression of tumorigenicity 2; PH: pulmonary hypertension; prec-PH: precapillary PH, postc-PH: postcapillary PH.

Figure 3. Scatterplot of correlation analysis between sST2 and RHC data. (A,B) Correlation between sST2 and mPAP in dependence of presence or absence of PH. (C,D) Correlation between sST2 and PAWP in dependence of presence or absence of PH. sST2: soluble suppression of tumorigenicity 2; mPAP: mean pulmonary arterial pressure; PAWP: pulmonary capillary wedge pressure; rs: correlation coefficient of Spearman.

Figure 4. AUROC curves, cut-off values and Youden Index for prediction of 1-year mortality (A,B) and for prediction of presence or absence of PH (C) according to sST2 serum levels. PH: pulmonary hypertension; sST2: soluble suppression of tumorigenicity 2; mPAP: mean pulmonary arterial pressure; AUC: area under the curve; CI: confidence interval.

Figure 5. Scatterplot of sST2 value pairs as a function of mPAP Group I (blue dots): mPAP < 25 mmHg + sST2 < 6990.12 pg/mL Group II (red dots): mPAP ≥ 25 mmHg + sST2 < 6990.12 pg/mL Group III (green dots): mPAP ≥ 25 mmHg + sST2 ≥ 6990.12 pg/mL Group IV (purple dots): mPAP < 25 mmHg + sST2 ≥ 6990.12 pg/mL. sST2: soluble suppression of tumorigenicity 2; mPAP: mean pulmonary arterial pressure.

Figure 6. Kaplan–Meier curves for detection of 1-year survival in dependence of several risk groups. (A) Group I (blue line): mPAP < 25 mmHg + sST2 < 6990.12 pg/mL; Group II (red line): mPAP ≥ 25 mmHg + sST2 < 6990.12 pg/mL; Group III (green line): mPAP ≥ 25 mmHg + sST2 ≥ 6990.12 pg/mL; Group IV (purple line): mPAP < 25 mmHg + sST2 ≥ 6990.12 pg/mL. Log-rank test Group I vs. Group II: p = 0.266; Group I vs. Group III: p = 0.027; Group I vs. Group IV: p = 0.249; Group II vs. Group III: p = 0.233; Group II vs. Group IV: p = 0.818; Group III vs. Group IV: p = 0.633. (B) Group I (blue line): mPAP < 25 mmHg + sST2 < 10,268.78 pg/mL; Group II (red line): mPAP ≥ 25 mmHg + sST2 < 10,268.78 pg/mL; Group III (green line): mPAP ≥ 25 mmHg + sST2 ≥ 10,268.78 pg/mL; Group IV (purple line): mPAP < 25 mmHg + sST2 ≥ 10,268.78 pg/mL. Log-rank test Group I vs. Group II: p = 0.255; Group I vs. Group III: p = 0.001; Group I vs. Group IV: p = 0.063; Group II vs. Group III: p = 0.009; Group II vs. Group IV: p = 0.326; Group III vs. Group IV: p = 0.651. sST2: soluble suppression of tumorigenicity 2; mPAP: mean pulmonary arterial pressure.