Role of stimulating growth factor 2 and galectin-3 in predicting the ventricular tachyarrhythmias in patients with ischemic cardiomyopathy

Aim. To assess the role of stimulating growth factor 2 (ST-2) and galectin-3 in predicting the ventricular tachyarrhythmias (VTA) in patients with coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) <35%.

Material and methods. The study included 40 patients (men, 36 (90,0%); median age, 64,5 [57,5; 68,5] years) with CAD, NYHA class IIIII heart failure, LVEF <35%, indications for implantable cardioverter defibrillator (ICD) (primary prevention of sudden cardiac death). Prior to ICD implantation, patients were measured for serum ST-2 and galectin-3 levels. For 18 months, patients were assessed for arrhythmic events recorded in the ICD memory.

Results. The 1^st group consisted of 10 (25,0%) patients who had VTA episodes, arrested by antitachycardia pacing or shock during 18-month follow-up. The 2^nd group consisted of 30 (75,0%) patients without VTA episodes. It was found that ST-2 concentration >22,48 ng/ml (p=0,02) and galectin-3 >10,95 ng/ml (p=0,009) corresponded to appropriate ICD discharge. Multivariate ROC analysis demonstrated that the only independent predictor of VTA was ST-2 elevation (odds ratio, 1,11; 95% CI, 1,01-1,21; p=0,023).

Conclusion. An increase in the concentration of both ST-2 >22,48 ng/ml and galectin-3 >10,95 ng/ml had a high predictive value in assessing the VTA risk in patients with ischemic cardiomyopathy. In multivariate analysis, an increase in ST-2 >22,48 ng/ml was an independent predictor of VTA.

1. Oganov RG, Gerasimenko NF, Pogosova GV, et al. Cardiovascular prevention: development strategies. Cardiovascular Therapy and Prevention. 2011;10(3):5-7. (In Russ.)

2. Ardashev AV, Arutyunov EG, Jelyakov EG, et al. The mechanisms and causes of sudden cardiac death. Risk factors and stratification in clinical practice. Basic definitions and terms. Clinical practice. 2014;4:3-12. (In Russ.)

3. Merchant FM, Jones P, Wehrenberg S, et al. Incidence of defibrillator shocks after elective generator exchange following uneventful first battery life. J Am Heart Assoc. 2014;3(6):1-7. doi:10.1161/JAHA.114.001289.

4. Mueller T, Dieplinger B. Soluble ST2 and galectin-3: what we know and do not know analytically. EJIFCC. 2016;27(3):224-37.

5. Dieplinger B, Mueller T. Soluble ST2 in heart failure. Clin Chim Acta. 2015;443:57-70. doi:10.1016/j.cca.2014.09.021.

6. Sabatine M, Morrow D, Higgins L, et al. Complementary roles for biomarkers of biomechanical strain ST2 and N-terminal prohormone B-type natriuretic peptide in patients with ST-elevation myocardial infarction. Circulation. 2008;117(15):1936-44. doi:10.1161/CIRCULATIONAHA.107.728022.

7. Hughes MF, Appelbaurn S, Havulinna AS, et al. ST2 may not be useful predictor for incident cardiovascular events, heart failure and mortality. Heart. 2014;100(21):1715-21. doi:10.1136/heartjnl-2014-305968.

8. Bayes-Genis A, de Antonio M, Vila J, et al. Head-to-head comparison of two myocardial fibrosis biomarkers for long-term heart failure risk stratification: ST2 versus galectin-3. J Am Coll Cardiol. 2014;63(2):158-66. doi:10.1016/j.jacc.2013.07.087.

9. Mueller T, Gegenhuber A, Leitner I, et al. Diagnostic and prognostic accuracy of galectin-3 and soluble ST2 for acute heart failure. Clin Chim Acta. 2016;463:158-64. doi:10.1016/j.cca.2016.10.034.

10. Grakova EV, Teplyakov AT, Kopieva KV, et al. Prediction role of a novel biomarker ST2 in risk assessment of adverse cardiovascular events in chronic heart failure with preserved and intermediate ejection fraction after myocardial revascularization. Cardiovascular Therapy and Prevention. 2018;17(5):40-6. (In Russ.)

11. Pascual-Figal DA, Ordonez-Llanos J, Tornel PL, et al. Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic dysfunction. J Am Coll Cardiol. 2009;54(23):2174-9. doi:10.1016/j.jacc.2009.07.041.

12. Skali H, Gerwein R, Meyer TE, et al. Soluble ST-2 and risk of arrhythmias, heart failure, or death in patients with mildly symptomatic heart failure: results from MADIT-CRT. J Cardiovasc Transl Res. 2016;9(5-6):421-8. doi:10.1007/s12265-016-9713-1.

13. Mozos I. Laboratory markers of ventricular arrhythmia risk in renal failure. Biomed Res Int. 2014;2014:509204. doi:10.1155/2014/509204.

14. de Boer RA, Voors AA, Muntendam P, et al. Galectin-3: a novel mediator of heart failure development and progression. Eur J Heart Fail. 2009;11(9):811-7. doi:10.1093/eurjhf/hfp097.