BACKGROUND
The role of revascularization in patients with ischemic heart failure is still controversial
and novel strategies are needed to identify patients in whom revascularization may
be of benefit. We set out to analyze whether viability and scar correlate with biomarkers
associated with increased myocardial wall stress, cardiac remodeling, myocyte apoptosis
and inflammation (NT-proBNP, ST2, TnT and hs-CRP).
METHODS AND RESULTS
Patients in the Imaging Modalities to Assist with Guiding Therapy in The Evaluation
of Patients with Heart Failure (IMAGE HF) study subproject, Alternative Imaging Modalities
in Ischemic Heart Failure (AIMI-HF), were included in this study. All patients undergoing
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) or single-photon emission
computed tomography (SPECT) with simultaneous biomarker analysis (NT-proBNP, soluble
ST2, hsTnT and hsCRP) were included. A total of 533 patients (mean age 67 ± 10 years,
86% male) with known or suspected ischemic heart failure (LVEF 28 ± 8 %) who needed
further assessment of ischemia or viability were recruited. In patients with hibernation
>10% the mean LogNTproBNP (pg/mL), LogTnT (pg/mL) and LogST2 (ng/mL) were significantly
higher compared to the patients with hibernation < 10% (8.5+/-1.3 vs 7.6 +/-1.3, p
< 0.000, 4.1+/-1.2 vs 3.6 +/-1.1, p=0.005 and 3.7+/-0.5 vs 3.4+/-0.4, p < 0.000, respectively).
In patients with scar >10% the mean Log TnT was significantly higher compared to the
patients with scar < 10% (3.8 +/-1.2 vs 3.3 +/-0.9, p=0.013). The relationship between
NTproBNP and hibernation remained significant after adjustment for LVEF, eGFR, age
and diabetes in a multivariable logistic model (OR 1.69, 95%CI 1.17-2.46, p=0.006).
CONCLUSION
In conclusion, NTproBNP, TnT and ST2 correlated with hibernation and TnT correlated
with scar in viability FDG-PET imaging. This data supports the novel concept that
elevated biomarkers could help with selecting patients who are the most likely to
benefit from revascularization and/or other procedures aiming to improve the myocardial
metabolism.
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© 2021 Published by Elsevier Inc.
