Abstract
BackgroundThis 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.MethodsA 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.ResultsThis 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).ConclusionsThe 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.
Highlights
This study sought to compare the predictive value of NT-proBNP, suppression of tumorigenicity 2 (sST2) and Matrix metalloproteinases (MMPs) in heart failure (HF) with different ejection fractions from a population in southern China
General information of HF patients with different ejection fractions Compared with indicators among HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF) and HF with reduced ejection fraction (HFrEF) groups, the results found that age, systolic blood pressure were statistically different among groups (P < 0.05), but there was no significant difference among three groups in gender, body mass index (BMI), diastolic blood pressure, triglycerides, total cholesterol, Low density lipoproteincholesterol (LDL-C), the rate of each HF phenotype taking HF treatment (P > 0.05) and other indicators, see Table 2
The results suggested that NTproBNP had a higher area under the curve (AUC) for the diagnosis of HFpEF than sST2, MMP-2 and MMP-9, and its sensitivity and specificity were higher
Summary
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. China is stepping into an aging society at present. The prevalence of heart failure (HF) become a serious problem due to the aging of population and the increased survival rate of patients with cardiovascular diseases. The plasma level of Nterminal of the prohormone brain natriuretic peptide (NT-proBNP) is considered to be a good reference in the diagnosis and prognosis of HF with reduced ejection fraction (HFrEF). NT-proBNP is susceptible to many non-cardiac factor [2], which presented to have some limitations in the diagnosis of HF with mid-range ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF) [3]. It is important to explore better biomarkers with high sensitivity and specificity for HFmrEF and HFpEF
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