Abstract
The aim of the study was to assess the prognostic value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction and their combination in this category of patients. Materials and methods. There were examined 120 patients with acute myocardial infarction and stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V. Kh. and Strazhesko M.D., NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) and non Q MI (60 individuals) were divided into 4 groups depending on the treatment methods. Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, which served as a basis for inclusion of the patients in the study. All the patients underwent the six-minute walk test in a quiet 30-50-m long hospital corridor in the morning. N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) and ST-2 were analyzed in all patients. Results. Promising biomarkers of HF decompensation in the post-infarction period were studied. In the patients with prior Q-QS MI and decompensated HF, NT-proBNP level was (950.38±3.15) pmol/l (p<0.05); in the patients with prior MI without signs of decompensated HF, it was (580.15±3.03) pmol/l (p˂0.05); in apparently healthy individuals, the level of NT-proBNP was found to be (111.20±3.47) pmol/l. ST2 level was (14.80±1.61) ng/ml, (36.00±1.43) ng/ml and (49.22±1.40) ng/ml in the patients of Group 1, Group 2 and Group 3, respectively (p˂0.05). Similar changes were found in patients with decompensated HF in postinfarction period after non Q MI. Conclusions. The increase in plasma concentration of sST2 is associated with the activation of both neurohumoral and fibrous pathways and can help in detecting the patients with decompensated HF in the post-infarction period and predicting the risk of its development. Our results confirmed the results of other multiple studies reporting ST2 in combination with NT-proBNP to be valuable tools for prognosing the development of decompensated HF in the patients with prior MI. ST2, alongside with NT-proBNP, is a promising biomarker to be included in the diagnostic panel for detecting acute HF and can provide additional information on risk stratification for such patients during hospitalization and at the time of discharge from the hospital.
Highlights
Heart failure (HF) is a syndrome affecting more than 5.7 million people annually and is the most frequent cause of hospitalization worldwide [1]
Materials and methods There were examined 120 patients with Q-QS wave and non-Q wave myocardial infarction (MI), stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V
The study allowed us to confirm that the patient’s response to graded exercises and serum levels of NT-proBNP and ST2 play the most significant role in clinical and prognostic assessing the post-infarction period complicated by decompensated HF
Summary
Heart failure (HF) is a syndrome affecting more than 5.7 million people annually and is the most frequent cause of hospitalization worldwide [1] It is a major public health challenge. B-type brain natriuretic peptide (BNP) is a hormone synthesized and secreted by cardiomyocytes in response to ventricular pressure and volume overload [5]. These peptides are known to play a crucial role in maintaining homeostasis in the cardiovascular system and serve as counter-regulatory hormones for pressure and volume overload [6]. Several factors can increase serum levels of natriuretic peptides They include age, female sex and renal insufficiency [8]. Low levels of these peptides during the observation period indicated the reduction in the effects of HF, while elevated levels were associated with unfavorable prognosis for patients [9, 10]
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