Key result
Higher soluble ST2 tracks pulmonary hypertension severity in CRT patients and decreases as pressures improve.
Why the study?
Pulmonary hypertension is an adverse prognostic marker in CRT patients, but the relation of biomarkers of fibrosis, wall stretch, and necrosis to its severity was unknown.
Do biomarkers like soluble ST2 correlate with pulmonary hypertension severity and predict outcomes in patients undergoing cardiac resynchronization therapy?
Cohort (n=111)
Do biomarkers like soluble ST2 correlate with pulmonary hypertension severity and predict outcomes in patients undergoing cardiac resynchronization therapy?
Answers are grounded in this paper and cite their sources.
Soluble ST2 levels correlate with pulmonary hypertension severity in CRT patients and serial changes may help monitor PH progression after CRT implantation.
BACKGROUND: Pulmonary hypertension (PH) is an adverse prognostic marker in patients undergoing cardiac resynchronization therapy (CRT). We sought to determine the relation of biomarkers of fibrosis [soluble ST2 (sST2), galectin-3], wall stretch [amino terminal pro-brain natriuretic peptide (NT-proBNP)], and necrosis [high-sensitivity troponin-I (hsTnI)] to PH severity in CRT patients. METHODS: Biomarkers and right ventricular systolic pressure (RVSP) were measured at CRT implant and 6-month later (n=111). PH was categorized into 3 groups based on RVSP: no (<35 mmHg), mild-moderate (35-60 mmHg), and severe (>60 mmHg). Patients were categorized as progressors (worsened PH), persistent PH (no change) and regressors (improved PH). Endpoints were 6-month CRT response and 2-year major adverse cardiac event (MACE). RESULTS: RVSP was associated with CRT nonresponse (P=0.02) and MACE (P=0.03). Severe PH patients had 5-fold increase risk for CRT nonresponse (OR 5.0, P=0.04) and MACE (HR 5.7, P=0.04) over non-PH patients. Progressors and persistent PH patients had >2-fold odds for CRT non-response (OR 2.8, P=0.45) and >11-fold increase in MACE compared to no PH patients or regressors (HR 11.6, P=0.02). Only NT-proBNP and sST2 were discernable between PH groups, with graded increase based on PH severity (both P≤0.02), and lower values in regressors versus non-regressors (both P≤0.01). Levels of sST2 decreased at 6 months in regressors (15 ng/mL, P=0.03) and increased slightly (3-8 ng/mL) in non-regressors, without difference for NT-proBNP (P=0.08). CONCLUSIONS: sST2 levels are related with PH severity in CRT patients. Serial sST2 changes after CRT implant suggests potential role to monitor PH after CRT.
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Beaudoin et al. (2019) conducted a cohort in Pulmonary hypertension in patients undergoing cardiac resynchronization therapy (n=111). Cardiac resynchronization therapy vs. No PH, mild-moderate PH, and severe PH was evaluated on 6-month CRT response and 2-year major adverse cardiac event (MACE) (HR 5.7, p=0.04). Soluble ST2 levels were associated with pulmonary hypertension severity in CRT patients, with levels decreasing at 6 months in patients with improved pulmonary hypertension (P=0.03).
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