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. 2024 Sep 27;14(1):22171.
doi: 10.1038/s41598-024-73349-0.

Natriuretic peptides and soluble ST2 improves echocardiographic diagnosis of elevated left ventricular filling pressures

Paul-Adrian Călburean  1   2 , Silvia Lupu  3   4 , Adina Huțanu  4 , Mădălina Oprica  4 , Diana Roxana Opriș  3   4 , Alexandru Stan  3   4 , Anda-Cristina Scurtu  3   4 , David Aniței  3 , Marius Harpa  3   4 , Klara Brînzaniuc  3   4 , Horațiu Suciu  3   4 , László Hadadi  3
Affiliations

Natriuretic peptides and soluble ST2 improves echocardiographic diagnosis of elevated left ventricular filling pressures

Paul-Adrian Călburean et al. Sci Rep. .

Abstract

Elevated filling pressure of the left ventricle (LV) defines diastolic dysfunction. The gold standard for diagnosis is represented by the measurement of LV end-diastolic pressure (LVEDP) during cardiac catheterization, but it has the disadvantage of being an invasive procedure. This study aimed to investigate the correlation between LVEDP and cardiac serum biomarkers such as natriuretic peptides (mid-regional pro-atrial natriuretic peptide [MR-proANP], B-type natriuretic peptide [BNP], and N-terminal prohormone BNP [NT-proBNP]), soluble ST2 (sST2), galectin-3 and mid-regional pro-adrenomedullin (MR-proAMD). Consecutive patients hospitalized in a tertiary center and undergoing left cardiac catheterization were included in the study. Diastolic dysfunction was considered present if the end-expiratory LVEDP was ≥ 15 mmHg. Cardiac biomarkers were determined from pre-procedural peripheral venous blood samples. A total of 110 patients were included, of whom 76 (69.0%) were males, with a median age of 65 (55-71) years. Median LVEDP was 13.5 (8-19) mmHg and diastolic dysfunction was present in 50 (45.4%) of the patients. LVEDP correlated with BNP (p < 0.0001, r = 0.39 [0.20-0.53]), NT-proBNP (p < 0.0001, r = 0.40 [0.22-0.55]), MR-proANP (p = 0.001, r = 0.30 [0.11-0.46]), sST2 (p < 0.0001, r = 0.47 [0.30-0.60]), but not with MR-proAMD (p = 0.77) or galectin-3 (p = 0.76). In the final stepwise multivariable binary logistic regression model, diastolic dysfunction was predicted by NT-proBNP, mitral average E/e', sST2, atrial fibrillation, and left atrium reservoir strain. BNP, NT-proBNP, MR-proANP, and sST2 had predictive value for diastolic dysfunction. In contrast, galectin-3 and MR-proAMD were not associated with increased filling pressures. Furthermore, NT-proBNP and sST2 significantly improved diastolic dysfunction prediction in the final multivariable model.

Keywords: B-type natriuretic peptide; Diastolic dysfunction; Galectin-3; Mid-regional pro-adrenomedullin.; Mid-regional pro-atrial natriuretic peptide; N-terminal prohormone B-type natriuretic peptide; Soluble ST2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Illustration of left ventricular pressure curve analysis. Left ventricular catheterization can reveal multiple phenotypes: (A) normal diastolic profile, (B) normal left ventricular end-diastolic pressure, but reduced minimum dp/dt, (C) high left ventricular end-diastolic pressure and reduced minimum dp/dt.
Fig. 2
Fig. 2
Correlation plot between left ventricular end-diastolic pressure and serum biomarkers.
Fig. 3
Fig. 3
Area under receiver operator curve for prediction of diastolic dysfunction.
See this image and copyright information in PMC

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