Markers of myocardial stress, fibrosis and inflammation in patients with chronic heart failure of different phenotypes and their relationship with echocardiography parameters

BACKGROUND: A generally accepted marker for confirming the diagnosis of acute and chronic heart failure (CHF) and risk stratification in such patients is the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP). In recent years, such biomarkers of myocardial fibrosis and remodeling as soluble suppressor of tumorigenicity 2 (sST2) and galectin-3, which have prognostic value, have been actively studied in patients with CHF. Considering the role of chronic inflammation in the pathogenesis of CHF, of interest is the assessment of the level of high-sensitivity C-reactive protein (hsCRP), which is a marker of inflammation. However, the characteristics of changes in these markers in patients with different phenotypes of CHF remain poorly understood in their comprehensive examination; the relationship between these indicators and echocardiography parameters (ECHO-CG) has not been studied. AIM: To evaluate the levels of sST2, galectin-3, NT-proBNP and hsСRP in the blood of patients with CHF of different phenotypes and their relationship with ECHO-CG parameters. METHODS: A total of 102 patients (72 women and 30 men, mean age 74.3 ± 9.1 years) hospitalized with decompensated CHF with the underlying grade II–III essential hypertension and/or II–III functional class exertion angina, were examined. Based on ECHO-CG results, the subjects were divided into 2 groups depending on the left ventricular (LV) ejection fraction (EF): group 1 — patients with preserved LVEF, group 2 — patients with moderately reduced and low LVEF. In all subjects, NT-proBNP, hsСRP, sST2 and galectin-3 levels were determined. RESULTS: In patients with CHF of group 2 sST2 and NT-proBNP levels were higher than in patients with CHF in group 1. Elevated sST2 concentration is associated with greater diameter of the aorta, LV end systolic dimension, right ventricle size, pulmonary artery systolic pressure (PASP) and lower LVEF. A ≥ 2-fold increase in NT-proBNP levels is associated with increased size of atria, PASP, pulmonary artery occlusion pressure, and decreased LVEF. A hsCRP level 5 mg/l is associated with increased PASP and pulmonary artery occlusion pressure. CONCLUSION: The progression of CHF is accompanied by an increase in sST2 and NT-proBNP, however, despite similar correlations with ECHO-CG parameters and supposed unidirectional action of markers in the development of the disease, there are differences, which in more detail reflect pathogenetic participation of molecules in CHF progression.