Evaluation of soluble sT2 and Galectin 3 levels in patients with heart failure

Introduction: Heart failure (HF) is a clinical syndrome which is defined as a structural and/or functional abnormality of the heart resulting in increased intracardiac pressures and/or insufficient cardiac output. Many biomarkers have been used so far to evaluate the diagnosis and prognosis in patients with HF and their clinical importance has been demonstrated. Soluble Stromelysin-2 (sST2) and Galectin-3 have been shown to correlate with prognosis in patients with HF. However, there is no study evaluating the clinical significance of sST2 and galectin-3 in HF classification according to ejection fraction (EF). In this study, we aimed to to examine the diagnostic value of sST2 and galectin-3 in HF classification based on EF. Materials and methods: Forty one HF with reduced EF (HFrEF), 41 HF with mildly reduced EF (HFmrEF), 41 HF with preserved EF (HFpEF) patients and 41 controls who applied to the cardiology outpatient clinic and whose consents were obtained were included in the study. Left ventricular EF ≤ 40% was defined as HFrEF, between 41% and 49% as HFmrEF, and ≥ 50% as HFpEF. The sST2 and Galectin-3 levels of the patients were measured and comparisons were made. Results: A total of 164 individuals, including 123 patients diagnosed with HF (HFrEF: 41, HFmrEF: 41 and HFpEF: 41) and 41 controls, were included in the study. In terms of basal characteristics; there was a significant difference among the four groups regarding gender (P=0.003) and body mass index (BMI) (P=0.001). In post hoc analyzes, the frequency of female gender and BMI were found to be significantly higher in HFpEF patients compared to HFrEF and HFmrEF groups. In terms of laboratory parameters; significant differences were found among the groups regarding urea (P=0.014), creatinine (P<0.001) and uric acid (P=0.007). In post hoc analyzes, HFrEF patients had significantly higher urea, creatinine and uric acid levels compared to the other groups. In addition, there was a significant difference among the groups in terms of sST2 (P<0.001) and Galectin-3 (P=0.007). In post hoc analyzes, sST2 and galectin-3 levels were found to be significantly higher in the HFmrEF and HFrEF groups compared to the control group. However, no significant difference was found between HFpEF and the control group in terms of sST2 and galectin-3. In the correlation analysis, sST2 level was positively correlated with BNP (r=0.240, XII P=0.002), whereas negatively correlated with EF (r=-0.403, P<;0.001). In addition, galectin-3 level was positively correlated with BNP (r=0.172, P=0.028), whereas negatively correlated with EF (r=-0.295, P<0.001). In ROC curve analysis, sST2 value ≥ 18.62 predicted HFrEF with a sensitivity of 73.2% and specificity of 75.6%, while galectin-3 value ≥ 7.61 predicted HFrEF with a sensitivity of 75.6% and specificity of 61%. In addition, sST2 value ≥ 18.78 predicted HFmrEF with a sensitivity of 68.3% and specificity of 75.6%, while galectin-3 value ≥7.17 predicted HFmrEF with a sensitivity of 75.6% and specificity of 58.5%. Conclusion: sST2 and galectin-3 levels are significantly higher in patients with HFrEF and HFmrEF, and the blood levels of these markers increase further as EF decreases. Both biomarkers may have a role in predicting patients with HFrEF and HFmrEF. Further studies with larger participants are needed to better understand the diagnostic importance of these biomarkers. Key words: Heart failure, soluble ST2, galectin-3