Background: The B-type natriuretic peptides, BNP and NTproBNP, are established markers of cardiac myocyte stretch advocated for diagnostic and prognostic use in heart failure patients. The evidence for serial monitoring to predict decompensation in heart failure has, however, been mixed. We examined serial concentrations of four novel biomarkers to ascertain superiority over NTproBNP in predicting cardiovascular admission; sST2 and Galectin-3, both markers of hypertrophy/fibrosis, and Apelin and Mid-regional pro-adrenomedullin (MRproADM) both markers of cardiac myocyte stretch.
Methods: We prospectively studied 50 patients with stable CHF due to LV systolic dysfunction. All patients were on optimum doses of prognostically indicated medications and in NYHA Class I-III. Mean age was 67.3 years (SD 11.568), 82% were male and 48% had IHD. Mean LVEF was 30.7%. Patients were followed for a period of 6 months with samples drawn at baseline, 1 month, 3 months and 6 months.
Results: On ROC analysis, AUC for % change in the respective biomarkers and CV admission was 0.803 (p = 0.012) for Galectin-3, 0.734 (p = 0.052) for sST2, 0.571 (p = 0.553) for Apelin, 0.506 (p = 0.962) for MRproADM and 0.571 (p = 0.553) for NTproBNP. Comparable results were found for absolute changes in biomarker concentrations with AUC of 0.807 (p = 0.011), 0.734 (p = 0.052), 0.417 P = 0.490), 0.546 (p = 0.700) and 0.579 (p = 0.511) respectively.
Conclusion: Markers of hypertrophy/fibrosis, sST2 and Galectin-3, are better predictors of CV admission than either NTproBNP or other novel markers of cardiac myocyte stretch. This may reflect longer-term adverse pathophysiological changes associated with hypertrophy and fibrosis compared with those of stretch. Further studies are required to corroborate these findings.