Circulating multimarker approach to identify patients with preclinical left ventricular remodelling and/or diastolic

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Olivier Huttin1,2, Masatake Kobayashi1, João Pedro Ferreira1

  • 1Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique, Inserm1433, CHRU Nancy, Inserm DCAC, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500 Vandoeuvre lès, Nancy, France.

ESC Heart Failure
|February 12, 2021
PubMed

Insights

A multimarker approach using fibrosis and inflammation biomarkers moderately improved the prediction of left ventricular hypertrophy (LVH) and diastolic dysfunction (DD) in a large population. While significant, the added predictive value in unselected individuals is marginal, suggesting further research for personalized screening.

Area of Science:

  • Cardiology
  • Biomarker Research
  • Population Health

Background:

  • Myocardial fibrosis and inflammation biomarkers are linked to left ventricular hypertrophy (LVH) and diastolic dysfunction (DD).
  • The combined predictive value of these biomarkers for LVH and DD in population studies remains under-investigated.

Purpose of the Study:

  • To assess the added value of a multimarker strategy (BNP, Galectin-3, P3NP, ST2) in detecting LVH and DD within a large population-based cohort.
  • To evaluate the predictive performance of these biomarkers using discrimination and reclassification analyses.

Main Methods:

  • Analysis of the STANISLAS cohort (1705 subjects).
  • Evaluation of brain natriuretic peptide (BNP), Galectin-3 (GAL3), N-terminal propeptide of procollagen type III (P3NP), and soluble ST2.
  • Utilized discrimination (C-index) and reclassification (NRI) to assess predictive ability for LVH and DD.

Main Results:

  • Subjects with LVH and/or DD showed elevated BNP, GAL3, and ST2 levels.
  • The addition of the four biomarkers significantly improved the prediction of LVH (delta C-index = 0.03) and DD (delta C-index = 0.01) over clinical variables.
  • Gal3, P3NP, and ST2 notably enhanced DD prediction (NRI = 31.3) beyond clinical factors and BNP.

Conclusions:

  • A multimarker approach offers a moderate but significant improvement in predicting LVH and DD in population studies.
  • The incremental predictive gain from Gal3, P3NP, and ST2 for preclinical DD in unselected individuals is marginal.
  • Further research into personalized medicine approaches combining proteomic and clinical data is warranted to enhance the detection of preclinical DD.
Abstract

Keywords:
BiomarkersBrain natriuretic peptideCollagenEchocardiography, DopplerHeart failure, diastolicLeft ventricleSystolic function

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