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Original articles
Published online: 2017-06-01
Submitted: 2017-03-24
Accepted: 2017-05-17
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The usefulness of soluble ST2 and galectin-3 as novel biomarkers for better risk stratification in hypertrophic cardiomyopathy

Monika Gawor, Mateusz Śpiewak, Jadwiga Janas, Katarzyna Kożuch, Aleksandra Wróbel, Łukasz Mazurkiewicz, Rafał Baranowski, Magdalena Marczak, Jacek Grzybowski
DOI: 10.5603/KP.a2017.0118

open access

Ahead of print
Original articles
Published online: 2017-06-01
Submitted: 2017-03-24
Accepted: 2017-05-17

Abstract

Background: Estimation of sudden cardiac death (SCD) risk is an integral part of clinical management of patients with hypertrophic cardiomyopathy (HCM). Identification of novel biomarkers of this disease can provide additional criteria for SCD risk stratification. Soluble suppression of tumorigenicity (sST2) and galectin-3 (Gal-3) are useful biomarkers for prognosis of heart failure (HF). Both of them appear to mediate cardiac fibrosis - an important pathogenetic process in HCM. Data about sST2 and Gal-3 usefulness in patients with HCM are limited.

Aim: The aim of this study was to evaluate sST2 and Gal-3 as potential novel biomarkers for better risk stratification in HCM.

Methods: Serum sST2 and serum Gal-3 levels were measured in 57 patients with HCM and 18 healthy controls. The patients with HCM underwent routine evaluation including medical history, physical examination, blood tests including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measurements, 12-lead electrocardiography (ECG), 48-hour Holter monitoring and two-dimensional (2D) echocardiography with the assessment of the maximal left ventricular wall thickness (MWT), left atrial diameter (LAD), maximal left ventricular outflow tract (LVOT) gradient and LV ejection fraction (LVEF). Risk of sudden cardiac death (SCD) at 5 years according to HCM SCD-risk calculator was evaluated. The control group underwent ECG, 2D echocardiography and NT-proBNP measurements to exclude asymptomatic heart disease.

Results: Concentrations of sST2 and Gal-3 were significantly higher in patients with HCM than in controls (14.9 +/- 5.8 ng/ml vs. 11.7 +/- 3.3 ng/ml, p=0.03 and 8.4 ng/ml [6.8 - 10.0] vs. 6.2 ng/ml [5.8 – 7.7], p=0.005, respectively). Levels of sST2 and Gal-3 were considerably different in the NYHA groups (p=0.008, p=0.009, respectively). Patients who presented non-sustained ventricular tachycardia (nsVT) on 48-hour Holter monitoring had higher levels of sST2 (19.1 ng/ml [12.2 - 24.2] vs. 13.2 ng/ml [10.0 – 17.1], p=0.02). There were no significant relationships between sST2 and Gal-3 levels and HCM SCD-risk, history of syncope presence, family history of SCD, and echocardiographic parameters.

Conclusions: Gal-3 levels and sST2 levels were higher in patients with HCM than in control group. There were significant differences in Gal-3 levels between NYHA classes, but no correlations between Gal-3 levels and other parameters were found. Apart from differences in sST2 levels between NYHA classes, we demonstrated higher levels of sST2 in patients with nsVT. These findings suggest that sST2 may be useful as an additional biomarker for better risk stratification in HCM.

Abstract

Background: Estimation of sudden cardiac death (SCD) risk is an integral part of clinical management of patients with hypertrophic cardiomyopathy (HCM). Identification of novel biomarkers of this disease can provide additional criteria for SCD risk stratification. Soluble suppression of tumorigenicity (sST2) and galectin-3 (Gal-3) are useful biomarkers for prognosis of heart failure (HF). Both of them appear to mediate cardiac fibrosis - an important pathogenetic process in HCM. Data about sST2 and Gal-3 usefulness in patients with HCM are limited.

Aim: The aim of this study was to evaluate sST2 and Gal-3 as potential novel biomarkers for better risk stratification in HCM.

Methods: Serum sST2 and serum Gal-3 levels were measured in 57 patients with HCM and 18 healthy controls. The patients with HCM underwent routine evaluation including medical history, physical examination, blood tests including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measurements, 12-lead electrocardiography (ECG), 48-hour Holter monitoring and two-dimensional (2D) echocardiography with the assessment of the maximal left ventricular wall thickness (MWT), left atrial diameter (LAD), maximal left ventricular outflow tract (LVOT) gradient and LV ejection fraction (LVEF). Risk of sudden cardiac death (SCD) at 5 years according to HCM SCD-risk calculator was evaluated. The control group underwent ECG, 2D echocardiography and NT-proBNP measurements to exclude asymptomatic heart disease.

Results: Concentrations of sST2 and Gal-3 were significantly higher in patients with HCM than in controls (14.9 +/- 5.8 ng/ml vs. 11.7 +/- 3.3 ng/ml, p=0.03 and 8.4 ng/ml [6.8 - 10.0] vs. 6.2 ng/ml [5.8 – 7.7], p=0.005, respectively). Levels of sST2 and Gal-3 were considerably different in the NYHA groups (p=0.008, p=0.009, respectively). Patients who presented non-sustained ventricular tachycardia (nsVT) on 48-hour Holter monitoring had higher levels of sST2 (19.1 ng/ml [12.2 - 24.2] vs. 13.2 ng/ml [10.0 – 17.1], p=0.02). There were no significant relationships between sST2 and Gal-3 levels and HCM SCD-risk, history of syncope presence, family history of SCD, and echocardiographic parameters.

Conclusions: Gal-3 levels and sST2 levels were higher in patients with HCM than in control group. There were significant differences in Gal-3 levels between NYHA classes, but no correlations between Gal-3 levels and other parameters were found. Apart from differences in sST2 levels between NYHA classes, we demonstrated higher levels of sST2 in patients with nsVT. These findings suggest that sST2 may be useful as an additional biomarker for better risk stratification in HCM.

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Keywords

sST2, galectin-3, hypertrophic cardiomyopathy, biomarker, HCM

About this article
Title

The usefulness of soluble ST2 and galectin-3 as novel biomarkers for better risk stratification in hypertrophic cardiomyopathy

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Ahead of print

Published online

2017-06-01

DOI

10.5603/KP.a2017.0118

Keywords

sST2
galectin-3
hypertrophic cardiomyopathy
biomarker
HCM

Authors

Monika Gawor
Mateusz Śpiewak
Jadwiga Janas
Katarzyna Kożuch
Aleksandra Wróbel
Łukasz Mazurkiewicz
Rafał Baranowski
Magdalena Marczak
Jacek Grzybowski

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