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Comparison of predictive value of NT-proBNP, sST2 and MMPs in heart failure patients with different ejection
Wei Pan1,2, Donghui Yang1,3, Peng Yu4
1Key laboratory of Geriatrics, Shengli Clinical Medical College of Fujian Medical University, Fujian Institute of Clinical Geriatrics, No.134, Road Dongjie, District Gulou, Fuzhou, 350001, P.R. China.
Insights
This study found that NT-proBNP, sST2, and MMP-2 are independent risk factors for heart failure (HF). Soluble ST2 (sST2) shows diagnostic and prognostic value, particularly in HF with mid-range ejection fraction (HFmrEF).
Area of Science:
- Biomarker discovery in cardiovascular disease
- Heart failure diagnostics and prognostics
- Proteomics and immunoassays in clinical research
Background:
- Heart failure (HF) is a complex syndrome with varying left ventricular ejection fraction (LVEF).
- Accurate diagnostic and prognostic biomarkers are crucial for managing HF patients.
- NT-proBNP, sST2, and matrix metalloproteinases (MMPs) are potential HF biomarkers.
Purpose of the Study:
- To compare the predictive value of NT-proBNP, sST2, and MMPs (MMP-2 and MMP-9) in heart failure patients with different ejection fractions.
- To evaluate the diagnostic and prognostic utility of these biomarkers in a southern Chinese population.
Main Methods:
- Cross-sectional study of 113 HF patients categorized into HFpEF (LVEF≥50%), HFmrEF (41%≤LVEF≤49%), and HFrEF (LVEF≤40%) groups.
- Quantification of plasma NT-proBNP, sST2, MMP-2, and MMP-9 using electrochemical luminescence immunoassay and ELISA.
- Statistical analysis included univariate/multivariate Cox and logistic regression, and Kaplan-Meier survival analysis.
Main Results:
- Plasma sST2 levels were significantly higher in HFrEF/HFmrEF compared to HFpEF patients.
- MMP-2 and MMP-9 levels were higher in HFrEF patients than in HFpEF/HFmrEF groups.
- NT-proBNP showed the highest AUC for HFpEF diagnosis (0.881), while sST2 was superior for HFmrEF (0.799). NT-proBNP also performed well in HFrEF (0.945).
- sST2, MMP-2, and NT-proBNP were identified as independent risk factors for HF.
- Elevated sST2 levels (≥ 0.332 ng/ml) predicted higher risks of endpoint events and lower survival rates in HFmrEF patients.
Conclusions:
- Circulating sST2, MMP-2, and NT-proBNP are independent risk factors in heart failure.
- sST2 demonstrates significant diagnostic and prognostic value, especially in HFmrEF.
- Higher sST2 levels correlate with an increased incidence of adverse outcomes in HF patients.
Background:
This study sought to compare the predictive value of NT-proBNP, sST2 and MMPs in HF with different ejection fractions from a population in southern China.
Methods:
A cross-sectional study was conducted on 113 HF patients admitted to Fujian Provincial Hospital from December 2016 to March 2018.The patients were divided into three subgroups: 60 cases in HFpEF group (LVEF≥50%), 28 cases in HFmrEF group (41% ≤ LVEF≤49%) and 25 cases in HFrEF group (LVEF≤40%). ELISA method was applied to detect the concentrations of sST2, MMP-2 and MMP-9. Electrochemical luminescence immunoassay was applied to detect the concentration of plasma NT-proBNP. Univariate and multivariate Cox and logistic regression models were used to analyze the diagnostic significance of these plasma biomarkers in HF patients. Kaplan-Meier survival curves were used to assess the prognostic value of sST2 in the incidence of long-term adverse events during study.
Results:
This study showed that plasma sST2 levels in HFrEF or HFmrEF patients were significantly higher than in HFpEF patients. Plasma levels of MMP-2 and MMP-9 in HFrEF patients were apparently higher than in HFpEF or HFmrEF patients. For the diagnosis of HFpEF, the AUC of NT-proBNP was higher than that of sST2, MMP-2 and MMP-9, which were 0.881, 0.717, 0.705 and 0.597, respectively. For the diagnosis of HFmrEF, the AUC of plasma sST2 was higher than that of MMP-2, MMP-9 and NT-proBNP, which were 0.799, 0.678, 0.676 and 0.793, respectively. For the diagnosis of HFrEF, the AUC of plasma NT-proBNP, sST2, MMP-2, and MMP-9 were 0.945, 0.820, 0.814, and 0.774 respectively. Spearman correlation analysis showed that plasma sST2 levels were significantly correlated with plasma MMP-2, MMP-9 and NT-proBNP levels. Further logistic regression analysis showed that except MMP-9, the biomarkers sST2 (OR = 1.960), MMP-2 (OR = 0.805) and NT-proBNP (OR = 0.002) were all independent risk factors for patients with heart failure. Survival analysis results suggested that for patients with HFmrEF, a higher level of plasma sST2 (≥ 0.332 ng/ml at admission) may predict a higher risk of endpoint events and a lower survival rate (P < 0.025).
Conclusions:
The circulating biomarkers sST2, MMP-2 and NT-proBNP were all independent risk factors for patients with heart failure. The sST2 can be a useful biomarker with both diagnostic and prognostic value in patients with HFmrEF. The higher sST2 level in patients with heart failure was related to a higher incidence of combined endpoint outcome.
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