Email this article Soluble suppression of tumorigenesis-2 (sST2), a new potential biomarker of response to cardiac resynchronization therapy and cardiac contractility modulation in patients with chronic heart failure
- Authors: Shlevkov N.B.1, Gasparyan A.Z.1, Zhambeev A.A.1, Salami H.F.1, Guseva E.V.1, Tarasovskiy G.S.1, Sharf T.V.1, Stukalova O.V.1, Gupalo E.M.1, Mironova N.A.1, Skvortsov A.A.1, Golitsyn S.P.1
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Affiliations:
- National Medical Research Cardiology Center
- Issue: Vol 49, No 2 (2021)
- Pages: 99-112
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1487
- DOI: https://doi.org/10.18786/2072-0505-2021-49-025
- ID: 1487
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Abstract
Background: According to numerous studies, from 30% to 50% of patients with chronic heart failure (CHF) are resistant to cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM), despite their careful selection in accordance with current guidelines. It is of interest to study neurohormones characterizing myocardial (NT-proBNP) and fibrosis (sST2) as potential additional markers of CHF patients' “response” to CRT and CCM.
Aim: To evaluate the potential to use NT-proBNP and sST2 biomarkers in CHF patients combined with transthoracic echocardiography (Echo) and contrast magnetic resonance imaging (MRI) parameters of the heart to predict a positive response to CRT and CCM devices.
Materials and methods: The study included 51 patients (41 men, 10 women) aged 58 ± 12 years (26 to 79 years) with ischemic heart disease post acute myocardial infarction (n = 22) or non-ischemic cardiomyopathy (n = 29), left ventricle (LV) ejection fraction (EF) < 35%, and CHF II–III NYHA functional class despite ≥ 3 months of optimized medical therapy. The patients were assessed by serum biomarkers NT-proBNP and sST2 measurements, transthoracic Echo, and contrast- enhanced cardiac MRI. After the diagnostic assessment, CRT defibrillators (CRT-D) were implanted to 39 patients and CCM to 12 patients. After prospective follow-up of the patients for 18 to 24 months, predictors of the response to each device type were analyzed in univariate, multivariate, and ROC analysis.
Results: The response to CRT-D was found in 21 (54%) patients, to CCM in 7 (58%) patients. Multivariate analysis showed the following predictors of the response of patients to CRT-D were: 1) sST2 < 50 ng/mL, 2) NT-proBNP < 3900 pg/mL, 3) < 3 LV segments with fibrosis (by MRI) and 4) anteroposterior dimension of the left atrium < 4.8 cm (by Echo). Any 2 of these 4 characteristics made it possible to predict the response to CRT with an accuracy of 87% (sensitivity 90%, specificity 83%). The predictors of the response to CCM were: 1) sST2 < 30 ng/ml, 2) LV end diastolic diameter < 78 mm (Echo), 3) age < 56 years, 4) body mass index < 27 kg/m2. Any 2 of these 4 characteristics predicted the positive response to CCM with an accuracy of 92% (sensitivity 86%, specificity 100%).
Conclusion: The preoperative sST2 level was the only universal marker of the response to either CRT (< 50 ng/mL) or CCM (< 30 ng/mL) devices in CHF patients with reduced LVEF. The results indicate the potential for improved efficacy of these devices with their earlier implantation after the onset of the heart disease, as well as provided that maximal control CHF in these patients has been achieved.
About the authors
N. B. Shlevkov
National Medical Research Cardiology Center
Author for correspondence.
Email: nik.shlevkov@inbox.ru
ORCID iD: 0000-0003-3956-1860
Nikolay B. Shlevkov – MD, PhD, Leading Research Fellow, Laboratory of Interventional Methods for Diagnostics and Treatment of Rhythm Disorders, Cardiac Conduction and Syncope, Department of Clinical Electrophysiology and X-ray Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияA. Zh. Gasparyan
National Medical Research Cardiology Center
Email: doctor_gasparyan@inbox.ru
ORCID iD: 0000-0001-9984-6505
Armenui Zh. Gasparyan – Postgraduate Student, Department of Clinical Electrophysiology and X-ray
Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияA. A. Zhambeev
National Medical Research Cardiology Center
Email: azhambeev@yandex.ru
ORCID iD: 0000-0002-3550-6111
Azamat A. Zhambeev – Postgraduate Student, Department of Clinical Electrophysiology and X-ray Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияH. F. Salami
National Medical Research Cardiology Center
Email: hussein_salami@mail.ru
ORCID iD: 0000-0001-9751-7767
Hussein F. Salami – MD, Cardiovascular Surgeon, Clinical Department No. 7a
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияE. V. Guseva
National Medical Research Cardiology Center
Email: gev1994@list.ru
ORCID iD: 0000-0001-6500-3649
Elena V. Guseva – Postgraduate Student, Department of Clinical Electrophysiology and X-ray Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияG. S. Tarasovskiy
National Medical Research Cardiology Center
Email: gena80@yandex.ru
ORCID iD: 0000-0002-2143-8912
Gennady S. Tarasovskiy – MD, Cardiologist, Clinical Department No. 7a
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияT. V. Sharf
National Medical Research Cardiology Center
Email: tsharf@rambler.ru
ORCID iD: 0000-0003-1993-9264
Tatiana V. Sharf – Research Fellow
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияO. V. Stukalova
National Medical Research Cardiology Center
Email: olgastukalova@mail.ru
ORCID iD: 0000-0001-8377-2388
Olga V. Stukalova – MD, PhD, Senior Research Fellow, Department of Tomography
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияE. M. Gupalo
National Medical Research Cardiology Center
Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0002-0063-5474
Elena M. Gupalo – MD, PhD, Research Fellow, Department of Clinical Electrophysiology and X-ray Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияN. A. Mironova
National Medical Research Cardiology Center
Email: mirona01@mail.ru
Nataliya A. Mironova – MD, PhD, Senior Research Fellow, Department of Clinical Electrophysiology and X-ray Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияA. A. Skvortsov
National Medical Research Cardiology Center
Email: skvortsov00@yandex.ru
ORCID iD: 0000-0003-2712-927X
Andrey A. Skvortsov – MD, PhD, Leading Research Fellow, Department of Myocardial Diseases and Heart Failure
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияS. P. Golitsyn
National Medical Research Cardiology Center
Email: golitsyn@mail.ru
ORCID iD: 0000-0001-9913-9974
Sergey P. Golitsyn – MD, PhD, Professor, Head of Department of Clinical Electrophysiology and X-ray Surgical Methods for Treatment of Heart Rhythm Disorders
15a 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation
РоссияReferences
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