Growth differentiation factor 15, ST2, high‐sensitivity troponin T, and N‐terminal pro brain natriuretic peptide in heart failure with preserved vs. reduced ejection fraction

Abstract

AimsGrowth differentiation factor 15 (GDF15), ST2, high-sensitivity troponin T (hsTnT), and N-terminal pro brain natriuretic peptide (NT-proBNP) are biomarkers of distinct mechanisms that may contribute to the pathophysiology of heart failure (HF) [inflammation (GDF15); ventricular remodelling (ST2); myonecrosis (hsTnT); and wall stress (NT-proBNP)]. Methods and resultsWe compared circulating levels of GDF15, ST2, hsTnT, and NT-proBNP, as well as their combinations, in compensated patients with clinical HF with reduced ejection fraction (HFREF) (n ¼ 51), HF with preserved ejection fraction (HFPEF) (n¼ 50), and community-based controls (n ¼ 50). Compared with controls, patients with HFPEF and HFREF had higher median levels of GDF15 (540 pg/mL vs. 2529 and 2672 pg/mL, respectively), hsTnT (3.7 pg/mL vs. 23.7 and 35.6 pg/mL), and NT-proBNP (69 pg/mL vs. 942 and 2562 pg/mL), but not ST2 (27.6 ng/mL vs. 31.5 and 35.3 ng/mL), adjusting for clinical covariates. In receiver operating characteristic curve analyses, NT-proBNP distinguished HFREF from controls with an area under the curve (AUC) of 0.987 (P , 0.001); GDF15 distinguished HFPEF from controls with an AUC of 0.936 (P , 0.001); and the combination of NT-proBNP and GDF15 distinguished HFPEF from controls with an AUC of 0.956 (P , 0.001). NT-proBNP and hsTnT levels were higher in HFREF than in HFPEF (adjusted P , 0.04). The NT-proBNP:GDF15 ratio distinguished between HFPEF and HFREF with the largest AUC (0.709; P , 0.001). ConclusionsOur study provides comparative data on physiologically distinct circulating biomarkers in HFPEF, HFREF, and controls from the same community. These data suggest a prominent role for myocardial injury (hsTnT) with increased wall stress (NT-proBNP) in HFREF, and systemic inflammation (GDF15) in HFPEF.Heart failure with preserved ejection fraction † ST2 † Growth differentiation factor 15 † High-sensitivity troponin T † N-terminal pro brain natriuretic peptide † These authors contributed equally to the study.

Clinical roles of soluble ST2 for the outcomes of cardiac valve operations

“…According to previous research, its trending has superior signal-to-noise and clinical relevance for cardiac prognosis to conventional biomarkers for heart failure such as NT-proBNP (Weinberg et al 2002, Pascual-Figal et al 2011a, Santhanakrishnan et al 2012). For valvular heart disease patients and their outcomes, we would like to investigate the association and predictive value of ST2 in cardiac surgical non-coronary valve patients.…”

“…Soluble ST2 (sST2) is a novel biomarker ) of fibrosis (Moore and Januzzi 2010) that reflects cardiac dysfunction such as remodeling or post-injury scaring (Sanada et al 2007, Weir et al 2010, Willems et al 2013, Díez 2008. According to previous research, its trending has superior signal-to-noise and clinical relevance for cardiac prognosis to conventional biomarkers for heart failure such as NT-proBNP (Weinberg et al 2002, Pascual-Figal et al 2011a, Santhanakrishnan et al 2012).…”

“…Soluble ST2 can reflect the process of cardiac remodeling and myocardial post-injury fibrosis in heart failure (Rehman et al 2008, Schmitz et al 2005, Moore and Januzzi 2010, and so it has much less confounding than conventional BNP/NT-proBNP (Mueller and Dieplinger 2013). When ST2 serum levels climb, it means there is considerable myocardial damage (Broch et al 2012, Lupón et al 2013.…”

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

“…Although less well studied than in HF with reduced ejection fraction, cardiac troponin concentrations are commonly increased in patients with HFpEF. Rates of increased cardiac troponin vary from 22%-44% (conventional assays) and from 55%-72% (hs-assays) but tend overall to be lower as compared to patients with reduced ejection fraction (60,61 ). Cardiac troponin concentrations in HFpEF are tightly associated with LV mass and size, left atrial diameter and the severity of diastolic dysfunction (62,63 ).…”

Czynnik różnicowania wzrostu 15 jako biomarker w niewydolności serca

“…Odróżnia to ten marker od NT-proBNP i troponin, których stężenia na ogół są wyższe u pacjentów ze zmniejszoną LVEF [22]. Zatem oznaczanie wyłącznie GDF-15 nie różnicowało tych dwóch postaci HF.…”