ST2 as a predictor of late ventricular remodeling after myocardial infarction

Abstract

ST2 is known to be heightened in the early phase after myocardial infarction, and associated with left ventricular remodeling (LVR). Explore the potential role of ST2 as a predictor for late LVR. Patients with a reperfused ST-segment elevation myocardial infarction (STEMI) were included in a prospective cohort. They underwent cardiac magnetic resonance (CMR) at 3 days (baseline), 3 and 12 months. Among 163 patients, 33 presented LVR as defined as a 10% change in LV end-systolic volume during follow-up. All patients were matched to 33 STEMI patients without LVR (non-remodelers) in term of age, gender, anterior infarction, baseline LV ejection fraction (LVEF) and infarct size. Early LVR ( n = 15) was defined as LVR occurring between baseline and 3 months, and Late LVR ( n = 18) as LVR occurring between 3 and 12 months. Usual CMR parameters were measured, so as global systolic wall stress (SWS). A biomarker analysis was performed at baseline and 3 months. Patients were 57 ± 10 years old, 85% were male. Early LVR patients presented with mean LVEF and infarct size of 48 ± 10.4% and 28 ± 15.6% LV; and Late LVR with 51 ± 11% and 16 ± 14.5% LV, respectively. At baseline, ST2 (46 ± 54.1 ng/mL), NT-proBNP (869 ± 1702 ng/L) and SWS (16.2 ± 7.1 10 3 N·m −2 ) were not different among the groups. At 3 months, Early LVR patients presented higher ST2, NT-proBNP and SWS (26 ± 12.7 ng/mL, 652 ± 1069 ng/L, 23 ± 9.7 10 3 N·m −2 for Early LVR, versus 21 ± 8.6 ng/mL, 354 ± 272.8 ng/L, 18 ± 7.3 10 3 N·m −2 for the corresponding non-remodelers, with P = 0.017, 0.040, and 0.036, respectively). Late LVR patients presented higher ST2 at 3 months than non-remodelers (34.4 ± 15.9 versus 22.1 ± 8.7 ng/mL, P = 0.046), while NT-proBNP and SWS were not different between groups at both time points ( Fig. 1 ). ST2 can be useful to predict LVR after STEMI.