Levels of sST2 and NT-proBNP biomarkers in patients with acute coronary syndrome and subclinical hypothyroidism

Authors

DOI:

https://doi.org/10.14739/2310-1210.2024.3.300258

Keywords:

biomarkers, sST2, NT-proBNP, acute coronary syndrome, heart failure, thyroid function, hypothyroidism, thyroid-stimulating hormone

Abstract

Aim. To evaluate the levels of soluble growth stimulator gene 2 (sST2) protein and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute coronary syndrome (ACS) depending on the presence of concomitant subclinical hypothyroidism (SH).

Materials and methods. 125 patients with ACS aged 36 to 81 years (mean age – 60.98 ± 0.81 years) were included in the study. All the patients were divided into two groups according to the state of thyroid function. Group I consisted of 51 patients (40.8 %) with SH (thyroid-stimulating hormone (TSH) level >4 μIU/mL), mean age – 62.51 ± 1.18 years; Group II – 74 patients (59.2 %) with normal thyroid function (TSH level 0.4–4.0 μIU/mL), mean age – 59.93 ± 1.08 years. The state of SH was diagnosed at a TSH level of >4.0 μIU/mL and a serum free thyroxine (FT4) level within the normal range.

Results. In the group of patients with ACS and SH (I), significantly higher mean levels of sST2 and NT-proBNP have been found compared to patients without thyroid dysfunction (II), 46.6 (27.9; 57.7) ng/ml (I) vs. 29.9 (22.0; 38.5) ng/ml (II), p = 0.001 and 173.0 (103.4; 1005.1) ng/l (I) vs. 95.9 (71.8; 178.6) ng/l (II), p = 0.0001, respectively. Among patients with ACS and SH (I), the sST2 level of 35–70 ng/ml was 1.94 times more often, and sST2 >70 ng/ml was 2.28 times more often as compared to those in patients with ACS without thyroid dysfunction (II), 22.74 % (47.06 ± 6.99 % (I) vs. 24.32 ± 4.99 % (II), p = 0.008) and 15.81 % (21.57 ± 5.76 % (I) vs. 9.46 ± 3.40 % (II), p < 0.05), respectively. The study on NT-proBNP levels in ACS patients with SH (I) has revealed a 75.67 % significantly higher proportion of individuals with NT-proBNP levels > 600 ng/L (33.33 ± 6.60 % (I)) as compared to ACS patients with normal thyroid function (II) (8.11 ± 3.17 % (II), p = 0.001). The level of NT-proBNP <125 ng/l has been detected 2.31 times more often in the group of ACS patients with normal thyroid function (II) compared to that in ACS patients with SH (I), by 36.06 % (63.51 ± 5.60 % (II) vs. 27.45 ± 6.25 % (I), p = 0.00002). A significant strong positive correlation has been found in the group of ACS patients with SH (I) (correlation coefficient (r) = 0.775, p < 0.001) in assessing the relationship between the mean levels of sST2 and NT-proBNP. In the group of ACS patients with normal thyroid function (II), a moderate correlation has been found between the mean levels of sST2 and NT-proBNP (r = 0.678, p < 0.001).

Conclusions. In the group of ACS patients with moderately reduced thyroid function (SH), significantly higher mean levels of sST2 and NT-proBNP and significantly higher percentage of individuals with sST2 levels ≥ 35 ng/mL, NT-proBNP >600 ng/L have been detected compared to the group of ACS patients with normal thyroid function. These results may indicate a higher risk of development, progression and complications of heart failure due to a higher probability of myocardial fibrosis and subsequent left ventricular remodeling in ACS patients with SH. The significant strong positive correlation has been found between the mean levels of sST2 and NT-proBNP in the group of ACS patients with SH (I) (r = 0.775, p < 0.001). In the group of ACS patients with normal thyroid function (II), the correlation between the mean levels of sST2 and NT-proBNP was less pronounced (r = 0.678, p < 0.001). Combined assessment of these biomarkers may be more informative for the diagnosis and prognosis of heart failure in ACS patients with concomitant thyroid dysfunction than measurements of individual biomarkers. In particular, the simultaneous increase in sST2 and NT-proBNP above reference values allows to identify a very high-risk group for heart failure occurrence and progression in ACS patients.

Author Biographies

N. B. Kuz, Danylo Halytsky Lviv National Medical University, Ukraine

Postgraduate Student at the Department of Family Medicine FPGE

T. M. Solomenchuk, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, DSc, Professor at the Department of Family Medicine FPGE

References

Castiglione V, Aimo A, Vergaro G, Saccaro L, Passino C, Emdin M. Biomarkers for the diagnosis and management of heart failure. Heart Fail Rev. 2022;27(2):625-43. doi: https://doi.org/10.1007/s10741-021-10105-w

Maisel A, Mueller C, Adams K Jr, Anker SD, Aspromonte N, Cleland JG, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008;10(9):824-39. doi: https://doi.org/10.1016/j.ejheart.2008.07.014

Aimo A, Januzzi JL Jr, Bayes-Genis A, Vergaro G, Sciarrone P, Passino C, et al. Clinical and Prognostic Significance of sST2 in Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74(17):2193-203. doi: https://doi.org/10.1016/j.jacc.2019.08.1039

Aimo A, Vergaro G, Ripoli A, Bayes-Genis A, Pascual Figal DA, de Boer RA, et al. Meta-Analysis of Soluble Suppression of Tumorigenicity-2 and Prognosis in Acute Heart Failure. JACC Heart Fail. 2017;5(4):287-96. doi: https://doi.org/10.1016/j.jchf.2016.12.016

Boisot S, Beede J, Isakson S, Chiu A, Clopton P, Januzzi J, et al. Serial sampling of ST2 predicts 90-day mortality following destabilized heart failure. J Card Fail. 2008;14(9):732-8. doi: https://doi.org/10.1016/j.cardfail.2008.06.415

Emdin M, Aimo A, Vergaro G, Bayes-Genis A, Lupón J, Latini R, et al. sST2 Predicts Outcome in Chronic Heart Failure Beyond NT-proBNP and High-Sensitivity Troponin T. J Am Coll Cardiol. 2018;72(19):2309-20. doi: https://doi.org/10.1016/j.jacc.2018.08.2165

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-61. doi: https://doi.org/10.1161/CIR.0000000000000509

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891-975. doi: https://doi.org/10.1002/ejhf.592

Gosi SK, Garla VV. Subclinical Hypothyroidism. 2023 Mar 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.

Yang G, Wang Y, Ma A, Wang T. Subclinical thyroid dysfunction is associated with adverse prognosis in heart failure patients with reduced ejection fraction. BMC Cardiovasc Disord. 2019;19(1):83. doi: https://doi.org/10.1186/s12872-019-1055-x

Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):1977-2016. doi: https://doi.org/10.1161/CIRCULATIONAHA.109.192064

Thayakaran R, Adderley NJ, Sainsbury C, Torlinska B, Boelaert K, Šumilo D, et al. Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study. BMJ. 2019;366:14892. doi: https://doi.org/10.1136/bmj.l4892

Biondi B, Bartalena L, Cooper DS, Hegedüs L, Laurberg P, Kahaly GJ. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J. 2015;4(3):149-63. doi: https://doi.org/10.1159/000438750

Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013;2(4):215-28. doi: https://doi.org/10.1159/000356507

Aleksova A, Paldino A, Beltrami AP, Padoan L, Iacoviello M, Sinagra G, et al. Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome-There is Meat on the Bone. J Clin Med. 2019;8(2):270. doi: https://doi.org/10.3390/jcm8020270

Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J. 2006;27(3):330-7. doi: https://doi.org/10.1093/eurheartj/ehi631

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: https://doi.org/10.1093/eurheartj/ehab368

Zhao YH, Gao H, Pan ZY, Li J, Huang WH, Wang ZF, et al. Prognostic Value of NT-proBNP After Ischemic Stroke: A Systematic Review and Meta-analysis of Prospective Cohort Studies. J Stroke Cerebrovasc Dis. 2020;29(4):104659. doi: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104659

Redford C, Vaidya B. Subclinical hypothyroidism: Should we treat? Post Reprod Health. 2017;23(2):55-62. doi: https://doi.org/10.1177/2053369117705058

Störk S, Handrock R, Jacob J, Walker J, Calado F, Lahoz R, et al. Epidemiology of heart failure in Germany: a retrospective database study. Clin Res Cardiol. 2017;106(11):913-22. doi: https://doi.org/10.1007/s00392-017-1137-7

Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Effects of thyroid hormones on the heart. Clin Investig Arterioscler. 2014;26(6):296-309. doi: https://doi.org/10.1016/j.arteri.2014.07.003

Pingitore A, Landi P, Taddei MC, Ripoli A, L'Abbate A, Iervasi G. Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med. 2005;118(2):132-6. doi: https://doi.org/10.1016/j.amjmed.2004.07.052

Zhang H, Li X, Zhang N, Tian L. Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14:1083171. doi: https://doi.org/10.3389/fendo.2023.1083171

Barasch E, Gottdiener J, Buzkova P, Cappola A, Shah S, DeFilippi C, et al. Association of thyroid dysfunction in individuals ≥ 65 years of age with subclinical cardiac abnormalities. J Clin Endocrinol Metab. 2024 Jan 6:dgae001. doi: https://doi.org/10.1210/clinem/dgae001

Maisel AS, Di Somma S. Do we need another heart failure biomarker: focus on soluble suppression of tumorigenicity 2 (sST2). Eur Heart J. 2017;38(30):2325-33. doi: https://doi.org/10.1093/eurheartj/ehw462

Published

2024-05-31

How to Cite

1.
Kuz NB, Solomenchuk TM. Levels of sST2 and NT-proBNP biomarkers in patients with acute coronary syndrome and subclinical hypothyroidism. Zaporozhye Medical Journal [Internet]. 2024May31 [cited 2024Jul.25];26(3):178-83. Available from: http://zmj.zsmu.edu.ua/article/view/300258