Abstract 4369175: Changes in N-terminal pro-B-type natriuretic peptide and soluble suppressor of tumorigenicity-2 during the transition from hospital to home in heart failure

Background: Major goals during a hospitalization for heart failure (HF) are adequate decongestion and hemodynamic optimization to avoid worsening symptom burden and rehospitalization. Tracking changes in biomarkers of HF, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) and soluble suppressor of tumorigenicity-2 (ST2), during the transition from hospital to home may help identify risk for worsening HF. Purpose: To quantify trajectories of change in plasma NT-proBNP and ST2 and predictors thereof over 6 months post-HF hospitalization. Methods: This is an analysis of interim data from a NIH-funded study of patients hospitalized for worsening HF. Data and plasma samples were collected prior to hospital discharge and again at 1 week and 1, 3, and 6 months post-HF hospitalization. Plasma NT-proBNP and ST2 were quantified using proximity extension assays as part of the Olink Proteomics Target 96 Cardiovascular III Panel; biomarker data are presented as normalized protein expression (NPX). Latent growth curve modelling was used to quantify trajectories of change in biomarkers and predictors thereof. Results: The sample (n=107) was 61.2±13.3 years and 42% female. The majority were NYHA Class III (72%) and had HF with reduced ejection fraction (60%), and the median length of stay was 8 days [interquartile range 6-12]. There was a significant linear decrease in NT-proBNP over 6 months (linear change = -0.08±0.03, p = 0.008; Figure 1A) and a significant non-linear decrease in ST2 (linear change = -0.15±0.04, p = 0.001; quadratic change = 0.02±0.01, p = 0.002; Figure 1B). Women had significantly lower NT-proBNP (difference = -0.97±0.42, p = 0.02) and lower ST2 (difference = -0.34±0.16, p = 0.03) at hospital discharge, but there was no significant sex difference in trajectory of change for either biomarker. Those with HFpEF had significantly lower NT-proBNP at hospital discharge (difference = -1.01±0.43, p = 0.02) but no significant difference in trajectory of change. There was no difference by HF type for ST2. Conclusion: There was a significant decrease in plasma NT-proBNP and ST2 over 6 months post-hospitalization for HF; although ST2 increased slightly at 6 months. Both female sex and HFpEF classification were significant predictors of baseline biomarker values.