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Left atrial rather than left ventricular impaired mechanics are associated with the pro‐fibrotic ST 2 marker and outcomes in heart failure with preserved ejection fraction
Author(s) -
Nagy A. I.,
Hage C.,
Merkely B.,
Donal E.,
Daubert J.C.,
Linde C.,
Lund L. H.,
Manouras A.
Publication year - 2018
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12723
Subject(s) - ejection fraction , medicine , cardiology , heart failure , diastole , odds ratio , confidence interval , prospective cohort study , confounding , biomarker , blood pressure , biochemistry , chemistry
Aims Left ventricular ( LV ) mechanics have been extensively investigated in heart failure with preserved ejection fraction ( HF p EF ) overshadowing for a long time the potential role of left atrium ( LA ) in that setting. Soluble suppression of tumorigenicity‐2 receptor ( ST 2) is a novel biomarker of pro‐fibrotic burden in HF . We hypothesized that due to the thinner LA wall, the fibrotic myocardial changes in HF p EF as indicated by elevated ST 2 levels might more readily be reflected by impairments in the LA rather than the LV performance. Methods and Results In 86 patients with HF p EF , enrolled in the Karolinska Rennes (KaRen) biomarker prospective substudy, global LA strain ( GL ‐ LS ) along with other echocardiographic as well as haemodynamic parameters and ST 2 levels were measured. ST 2 levels were inversely associated with LA ‐ GS ( r = −0.30, P = 0.009), but not with LA size, LV geometry, systolic or diastolic LV function ( P > 0.05 for all). Furthermore, symptom severity correlated with ST 2 and LA ‐ GS , but not with LV structural or functional indices. Finally, during a median 18‐month follow‐up, LA ‐ GS independently predicted the composite endpoint of HF hospitalization and all‐cause mortality, even after adjustment for potential clinical and cardiac mechanical confounders, including LV global longitudinal strain and filling pressures (odds ratio: 4.15; confidence interval: 1.2–14, P = 0.023). Conclusions Reduced LA ‐ GS but not LV functional systolic and diastolic parameters were associated with the pro‐fibrotic ST 2 marker, HF symptoms and outcome in HF p EF .