Résumé
Heart failure is the most frequent cardiac complication of chronic kidney disease (CKD). Biomarkers can help identifying high-risk patients. Natriuretic peptides are largely used for monitoring patients with cardiac failure, but are highly dependent of GFR. Soluble suppressor of tumorigenicity 2 (sST2) is identified in risk stratification of cardiovascular events (CVE) in heart failure. Furthermore, sST2 could be included in a bioclinical score to stratify mortality risk.
The aim of this study is to evaluate the interest of circulating sST2 level in heart dysfunction, the bioclinical score to predict risk of composite outcome (major adverse coronary events) as well as mortality prediction for CKD patients.
A retrospective study was carried out on 214 patients enrolled from 2004 to 2015 at Montpellier University Hospital. sST2 was measured with Presage ST2® kit. CKD status was defined by the CKD-epi equation to estimate GFR. Indices of cardiac parameters were performed by cardiac echography.
No patient had reduced ejection fraction. 109 patients had left ventricular hypertrophy, and 181 had diastolic dysfunction, with structural, functional abnormalities or both. sST2 is independent of age and eGFR (P=0.44, r=0.05 and P=0.3, r=0.07, respectively). Regarding echocardiogram data, sST2 is correlated with left ventricular mass index (P=0.02, r=0.16), left atrial diameter (P=0.04, r=0.14) and volume index (P=0.05, r=0.13) and). sST2 alone does not change risk prediction of death and/or CVE compared to cardiac biomarkers. Included in a bio-clinical score sST2 has added value and better stratifies the risk of CVE and/or death in CKD patients.
sST2 is associated with cardiac remodeling independently of eGFR, unlike other cardiac biomarkers (hs-cTnT and NT-proBNP). Included in a bioclinical score, it allows a better risk stratification of death and/or CVE in early stages of CKD patients.