Evaluation of ST2 as an early marker of heart failure with a preserved left ventricular ejection fraction in patients with persistent atrial fibrillation

Abstract

Aim. To assess the diagnostic value of soluble ST2 (sST2) for early detection of heart failure with a preserved ejection fraction (HFpEF) in patients with persistent atrial fibrillation (AF).Material and methods. A total of 165 patients hospitalized with AF paroxysm were examined. The inclusion criteria were the persistent AF and LVEF >50% according to echocardiography. A cohort of 60 patients with persistent AF and preserved LVEF was formed. Patients were divided into 2 equal groups of 30 people depending on the HF presence, assessed on the basis of LV diastolic dysfunction with or without left atrial enlargement >34 ml/m2 or left ventricular mass index >110 g/m2 in men and 95 g/m2 in women, as well as an increase in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) >125 pg/ml. LVEF was calculated using the Simpson method; assessment of LV diastolic function was carried out with determination of transmitral flow velocity characteristics and visualization of mitral annulus motion. The NT-proBNP concentration was determined in blood serum using the Biomedica Group reagent (Austria), sST2 — using Presage ST2 (Critical Diagnostics, USA) by enzyme-linked immunosorbent assay on an Immulite 1000 analyzer (DPC, USA).Results. In patients with HFpEF and persistent AF, the correlation analysis showed a direct strong relationship between NT-proBNP and sST2 (r=0,726; p<0,05). To assess sST2 as a diagnostic criterion for HF, ROC curve was constructed. It was shown that with sST2 ≥16 ng/ml (AUC=0,89), the sensitivity of the method was 80%, the specificity — 83%.Conclusion. In patients with a persistent AF, serum sST2 concentration ≥16 ng/ml can be used as an alternative to the NT-proBNP criterion for early diagnosis of HFpEF.