Author + information
- Jigar Contractor,
- Roderick Deano,
- Jackie Szymonifka,
- Qing Zhou,
- Jonathan Beaudoin,
- James Januzzi,
- Jagmeet Singh and
- Quynh Truong
We aim to determine the relation of soluble ST2 (sST2), a novel biomarker of cardiac stress, to the severity of pulmonary hypertension (PH) in cardiac resynchronization therapy (CRT) patients.
In 111 patients (age 65±13, 77% male) sST2 levels and Echo right ventricular systolic pressure (RVSP) were measured at CRT implant. PH severity was categorized into 3 groups (Figure A): no, mild-moderate, and severe PH. In serial 6-month analyses, 79 patients had RVSP values; 35 of whom also had sST2 measured. We defined PH “progressors” as those with worsened PH severity, “persistent” as no change in PH severity, “regressors” as improved PH severity, and no PH as those without PH. Primary endpoint was 2-year major adverse cardiac event (MACE).
Severe PH patients had 5-fold increase risk of MACE (adjusted HR 5.7, p=0.04) over non-PH patients. Figure A shows a gradient increase in baseline median sST2 levels with worsening PH severity (p=0.02). CRT patients without PH had no MACE (Figure B). Compared to regressors, progressors had 6-fold increase in MACE (HR 6.2, p=0.02) while persistent PH patients trended to higher MACE (HR 3.3, p=0.06). PH regressors had reduction in sST2 levels (-15 ng/mL) compared to non-regressors with sST2 increase (+5 ng/mL, p=0.005).
Baseline sST2 concentrations are associated with PH severity in CRT patients. Serial sST2 reduction in regressors suggests this cardiac stress biomarker may play a mechanistic role in adverse outcome in CRT patients with PH.
Poster Area, South Hall A1
Monday, April 04, 2016, 9:45 a.m.-10:30 a.m.
Session Title: Clinical Care of Patients With Implanted Devices
Abstract Category: 18. Arrhythmias and Clinical EP: Devices
Presentation Number: 1266-326
- 2016 American College of Cardiology Foundation