Introduction: Pulmonary hypertension (PH) is a disease with an unfavorable prognosis, characterized by increasing in pulmonary resistence and right heart failure. One of the most important prognostic factors is the adaptation of the right ventricle to increased pressure overload, witch can be evaluated through tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/PAPs), a prognostic echocardiographic index of right ventricle-pulmonary artery coupling. In this setting, NT-proBNP , until now, is the only biomarker that, reflecting right ventricular function, gives prognostic information. However, NT-proBNP levels are influenced by age, body mass index, sex and comorbidities, such as anemia and renal failure. In previous studies soluble- Suppression of Tumorigenicity (s-ST2), a marker of myocardial stress, resulted a strong predictor of death in heart failure, acute coronary syndromes and pulmonary hypertension.
Aim: Our purpose is to study the possible correlation between sST2 and different echocardiographic parameters, in particular TAPSE/PAPs.
Methods: This is a prospective study conducted on 45 PH patients (75% affected by pulmonary arterial hypertension), which were followed for survival. They underwent echocardiography, right heart catheterization and venous sampling to measure s-ST2 levels.
Results: During an average 18-month follow-up, 17 patients died, 76% of whom had pulmonary arterial hypertension (PAH). sST2>78 ng/ml represents a numerical value with the highest association with mortality in our study population: at 6-12 months the patients with sST2>78 ng/ml showed statistically significant early higher mortality in comparison with sST2 <78 ng/ml patients. Patients with sST2>78ng/ml had statistically significantly higher right ventricular inflow diameter, reduced tricuspid annular planer systolic excursion, greater right atrial area, lower pulmonary artery acceleration time and lower TAPSE/PAPs, compared with patients with sST2<78 ng/ml values. We showed a statistically significant inverse correlation between sST2 and TAPSE/PAPs. Conclusions: s-ST2, predicting right ventricular/pulmonary artery coupling through TAPSE/PAPs, represents an usefull and promising marker in noninvasive hemodynamic assessment and risk stratification of PH patients.
