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. 2025 Apr 14;26(8):3713.
doi: 10.3390/ijms26083713.

Natriuretic Peptides and Soluble ST2 Improve Echocardiographic and Invasive Long-Term Survival Prediction in Patients Evaluated for Diastolic Dysfunction

Horațiu Suciu  1   2 , Paul-Adrian Călburean  3 , Adina Huțanu  4   5 , Mădălina Oprica  5 , Diana Roxana Opriș  6 , Anda-Cristina Scurtu  6 , Alexandru Stan  6   7 , David Aniței  2 , Klara Brînzaniuc  8 , László Hadadi  7 , Marius Harpa  1   2
Affiliations

Natriuretic Peptides and Soluble ST2 Improve Echocardiographic and Invasive Long-Term Survival Prediction in Patients Evaluated for Diastolic Dysfunction

Horațiu Suciu et al. Int J Mol Sci. .

Abstract

This study aimed to investigate the impact of long-term survival on cardiac serum biomarkers such as natriuretic peptides (mid-regional pro-atrial natriuretic peptide [MR-proANP], B-type natriuretic peptide [BNP], 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, undergoing echocardiographic and invasive left cardiac catheterization for diastolic dysfunction assessment were prospectively included in this study. Cardiac biomarkers were determined from pre-procedural peripheral venous blood samples. A total of 110 patients were included, with a median follow-up of 1.66 (1.23-2.16) years during which 16 (14.5%) patients died. A total of 45.4% (50) of patients had diastolic dysfunction. In the univariate Cox regression, long-term survival was predicted by BNP (p < 0.0001, HR = 0.39 [0.20-0.53]), NT-proBNP (p < 0.0001, HR = 0.40 [0.22-0.55]), MR-proANP (p = 0.001, HR = 0.30 [0.11-0.46]), sST2 (p < 0.0001, HR = 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 Cox regression non-invasive and invasive models, NT-proBNP and sST2 remained independent predictors of survival. Natriuretic peptides (BNP and NT-proBNP) and sST2 were predictors of long-term survival, while MR-proANP, MR-proADM and galectin-3 did not have predictive values. NT-proBNP and sST2 improved survival prediction in both a non-invasive scenario (including clinical, serum and echocardiographic parameters) and an invasive clinical scenario (including left heart catheterization parameters). The sST2 pathway could provide a target for therapeutic intervention.

Keywords: B-type natriuretic peptide; N-terminal prohormone B-type natriuretic peptide; galectin-3; mid-regional pro-adrenomedullin; mid-regional pro-atrial natriuretic peptide; soluble ST2.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Impact of left heart catheterization-derived parameters on long-term survival. Median values were used as cut-off.
Figure 1
Figure 1
Impact of left heart catheterization-derived parameters on long-term survival. Median values were used as cut-off.
Figure 2
Figure 2
Impact of serum biomarkers on long-term survival. Median values were used as cut-off.
Figure 2
Figure 2
Impact of serum biomarkers on long-term survival. Median values were used as cut-off.
Figure 3
Figure 3
Illustration of left ventricular pressure curve analysis. (A)-Low-risk patient with low ejection fraction, normal diastolic function and normal serum biomarkers, but without events during long follow-up. (B)-High-risk patient with normal ejection fraction, impaired diastolic function and high serum biomarkers, who died during follow-up. (C)-High-risk patient with low ejection fraction, impaired diastolic function and high serum biomarkers, who died during follow-up.
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