Document Type : Original Article

Authors

Department of Cardiovascular Medicine, Kasr Alainy hospital, Faculty of Medicine, Cairo University, Egypt.

Abstract

Background: Suppression of tumorigenicity 2 (ST2) is a biomarker of myocardial fibrosis and remodeling proven to predict outcomes in patients with acute decompensated heart failure (ADHF), especially when measured serially. We aimed to evaluate right ventricular (RV) dynamic changes in ADHF patients using serum soluble ST2 (sST2) and speckle-tracking echocardiography imaging (STE).
 
Methods: We enrolled 61 ADHF patients with left ventricular ejection fractions below 50% and serum NT-proBNP levels exceeding 900 pg/mL. Serum sST2 levels were measured on hospital admission and discharge. The patients underwent serial conventional and STE examinations on admission, at 48 hours, and on discharge. RV STE analysis was done using 2D cardiac performance analysis.
 
Results: Serum sST2 had a significant positive correlation with serum NT-proBNP on admission (r = 0.84, P < 0.0001) and showed a significant reduction from 2.47 (1.27–4.05) ng/mL on admission to 1.86 (1.06–3.24) ng/mL at discharge (P < 0.0001), denoting successful decongestion. Significant decreases were observed in the inferior vena cava diameter (P < 0.0001) and the estimated pulmonary artery systolic pressure (P = 0.002); however, the changes were not associated with a significant change in RV dimensions (P > 0.05) or contractility assessed by trans-annular plane systolic excursion (P = 0.09) and tricuspid S-wave velocity (P = 0.9). There was a significant improvement in RV free wall strain (RVFWS) (P = 0.005) assessed by STE, primarily noticed after the first 48 hours until discharge, but the RV 4-chamber strain did not change significantly (P = 0.06).
 
Conclusions: RVFWS assessed by STE can detect improvements in RV systolic function not detected by conventional echocardiographic parameters in ADHF patients. Together with declines in serum sST2 levels, it can be used as a marker of improved cardiac mechanics and successful decongestion. (Iranian Heart Journal 2023; 24(4): 42-53)

Keywords