Associazione Nazionale Medici Cardiologi Ospedalieri




Novielli Maria Elena Acquaviva delle Fonti(BARI) – Ente ecclesiastico ospedale generale regionale “Miulli”-UOC Geriatria | De Tommasi Elisabetta Bari(Ba) – Policlinico di Bari-Cardiologia Ospedaliera | Camassa Nino Bari(Ba) – Policlinico di Bari-Cardiologia Ospedaliera

Introduction: According to ESC 2022 guidelines, pulmonary hypertension (PH) is a hemodynamic condition characterized by mean pulmonary arterial pressure>20 mmHg. Pulmonary arterial hypertension (PAH) represents 5% of the PH, with an unfavorable prognosis primarily because of late diagnosis and treatment. In PAH, it is important to evaluate the individual patient mortality risk through a multiparametric approach: a three-layer model at diagnosis and a four-layer model based on WHO-FC, 6MWD and NT-proBNP at follow up, which allows better discrimination within the intermediate risk group helping therapeutic decision making. The only biomarker included in risk stratification is NT-proBNP; however, in previous studies soluble-Supression of Tumorigenicity 2(s-ST2), a marker of myocardial stress, resulted a strong predictor of death in heart failure and acute coronary syndromes.

Aim: the aim of this study is to analyze the prognostic value of s-ST2 in patients with pulmonary hypertension.

Methods: This is a prospective study conducted on 45 PH patients (75% PAH), which were followed for survival. They underwent echocardiography, venous sampling to measure s-ST2 levels, right heart catheterization. All the patients were followed for survival.

Results: During an average 18-month follow-up, 17 patients died, 76% of whom had pulmonary arterial hypertension (PAH). They showed significantly higher values of s-ST2. 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 (Fig. 1). At multivariate analysis s-ST2>78 ng/ml is confirmed to be a statistically significant predictor of mortality, regardless of WHO functional class III-IV, PAPs and NT-proBNP. Furthermore, s-ST2 appears a better early mortality predictor than NT-proBNP, at the limit of statistical significance (Fig. 2).

Conclusions: In a population of patients with pulmonary hypertension (predominantly PAH) we define a numerical value of sST2>78 ng/ml, which is a prognostic discriminator, independent and incremental to NT-proBNP at short-term follow-up. It allows the clinician the appropriate planning of therapeutic strategies in a condition in which the earliness of therapy affects prognosis.