Soluble ST2 and renal function in ischemic heart failure with atrial fibrillation

Funding Acknowledgements Type of funding sources: None. Soluble ST2 (sST2) is a novel cardiac biomarker whose concentration rises in response to myocardial strain. The aim of this study was to analyse the relationship between soluble ST2 (sST2) level and renal function in heart failure (HF) patients with atrial fibrillation (AF). Methods The study involved 113 (83.2% men) patients with mean age 60.0 [54.0-67.0] years with II-IV functional class (recommendations of the New York Heart Association) is due to ischemic heart disease. Serum levels of N-terminal proBNP (NT-proBNP), sST2, TIMP-1 and Cystatine C (CysC) were quantified by ELISA of 33 patients with HF and AF and 80 patients with HF without AF. Echocardiography was performed according to the American Society of Echocardiography/European Association of Echocardiography recommendations. Estimated glomerular filtration rate (eGFR) was calculated by MDRD formula. Nonparametric Mann-Whitney U-test for independent data, Spearman’s rank correlation and multiple linear regression coefficients were calculated. Results Patients with HF and AF characterized significantly higher concentration of sST2 (1453.2 [1184.3-1945.7] vs 1279.7 [1110.9-1616.6] pg/ml, p = 0.05), as well as the marker of kidney dysfunction CysC (1375 [1111.7-1867.4] vs 1136.4 [955-1386.4] ng/ml, p = 0.02) and was significantly lower eGFR (67.7 [60.6-77.2] vs 79.3 [70.9-88.0] ml/min/1.73m2; p = 0.0002). sST2 correlated with TIMP-1 (r = 0.56; p = 0.004) E/e’ (r = 0.87; p = 0.002), as well as CysC with NT-proBNP (r = 0.56; p = 0.002), with age (r = 0.49; p = 0.009) in patients with HF and AF. At multivariate linear regression analysis, only TIMP-1 (β=0.63) and left atrial volume index (β=0.22) were independently associated with sST2 (R2 = 0.58; p = 0.002). Conclusions In patients with ischemic HF and atrial fibrillation elevation sST2, associated with high level cystatine C and correlated with TIMP-1, E/e’, markers which showed abnormal collagen homeostasis and significant diastolic dysfunction LV. Multivariate analysis shows, that sST2 independently associated with TIMP-1 and LAVi. Further studies are needed to clarify the prognostic role of marker renal function (CysC) and cardiovascular stress (sST2) in ischemic HF patients with atrial fibrillation.

A COMPARATIVE ASSESSMENT OF SERUM CREATININE AND CYSTATIN C AS A SIGNIFICANCE OF NEPHROPATHY IN DIABETIC PATIENTS

The critical micro-vascular complications of diabetes ultimately result in renal dysfunction known as diabetic nephropathy (DN). Measurement of glomerular filtration rate (GFR) is considered to be an important parameter in renal function assessment, evaluating GFR by Creatinine level. Recently, Cystatin C is used as a substitute indicator in several studies to assess diabetic nephropathy. This work was conceived to determine whether serum cystatinC would replace serum creatinine (Scr) in patients with type2 diabetes for early evaluation of nephropathy. A Case-Control Study was enrolled on 30 Patients with diabetic and 30 apparently healthy as control, aged between 25 - 83 years. Levels of serum cystatine C and serum Creatinine were calculated for both groups. Serum Creatinine, as well as serum cystatin C levels, was significant relationship with diabetic pt. in compared to non-diabetic individuals. ROC analysis noted the cystatinC was more predict indicator in diagnosed Diabetic Nephropathy (DNP) from Serum Creatinine level. In Type 2 diabetics, CystatinC is a good marker for uncontrolled diabetic nephropathy relative to serum creatinine.