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).
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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