Prognostic significance of NT-proBNP and sST2 in patients with chronic heart failure and reduced ejection fraction after previous decompensation

Objective. To assess the risk of cardiovascular complications in patients with heart failure and reduced ejection fraction (HFrEF) depending on sST2 and NT-proBNP concentrations at discharge and in long-term follow-up after treatment of acute decompensated heart failure (ADHF). Material and methods. The study included 132 patients hospitalized for decompensated HFrEF due to coronary artery disease, dilated cardiomyopathy, and hypertension. Serum sST2 and NT-proBNP were analyzed at baseline, upon discharge, after 30, 90 and 180 days. The follow-up period was one year. We analyzed cardiovascular events including episodes of decompensation/hospitalization for HF and cardiovascular mortality. Results. The risk of cardiovascular events decreases within a year after discharge in case of serum sST2 and NT-proBNP at discharge <29.3 ng/mL (AUC 0.631±0.050, 95% CI: 0.534–0.728, p=0.010) and 2647 pg/mL (AUC 0.615±0.050, 95% CI: 0.518–0.713, p=0.024), respectively. Serum sST2≤23.4 ng/ml (AUC 0.746±0.051, 95% CI: 0.647–0.846, p<0.001) or decrease by ≥34.3% (20.8; 48.2), as well as NT-proBNP≤1132 pg/ml (AUC 0.757±0.049, 95% CI: 0.660–0.853, p<0.001) or decrease by ≥38.9% within 6 months was associated with lower risk of cardiovascular complications. This risk was high without simultaneous decrease of both biomarkers (OR=6.583; 95% CI 3.448–12.569, p<0.001). Conclusion. To reduce the risk of cardiovascular complications, it is necessary to achieve simultaneous decrease of sST2 ≤23.4 ng/ml or by ≥34.3% and NT-proBNP ≤1132 pg/ml or by ≥38.9%.