THE ROLE OF BIOMARKERS AND sST2 IN THE DEVELOPMENT OF POSTINFARCTION CHF IN ELDERLY PATIENTS

Highlights

• Biomarkers associated with inflammation (hf-CRP, NLR, SIRI) and fibrosis (sST-2) are associated with chronic heart failure and are predictors of worsening heart failure.
• The results obtained in elderly patients confirm the expediency of measuring the level of soluble ST2 to assess the clinical course of CHF after a myocardial infarction without ST elevation.
• Unlike traditional biochemical markers of inflammation, the calculation of NLR and SIRI indices based on a general blood test requires less time, which contributes to their more active implementation in medical practice.

Background. One of the leading causes of chronic heart failure (CHF) in elderly patients is a recent myocardial infarction. There is particular interest in inflammatory biomarkers – those detectable via a complete blood count – and soluble ST2 (sST2) as a marker of myocardial fibrosis and remodeling. However, their role in the development of CHF during the post‑infarction period in elderly patients has not been sufficiently studied.

Aim. To conduct a comprehensive assessment over a six‑month prospective follow‑up period of potential relationships between inflammatory biomarkers (C‑reactive protein, NLR, MLR, SII, SIRI) and soluble ST2 (sST2). Additionally, the objective is to determine their diagnostic significance in chronic heart failure among elderly patients who have experienced a non‑ST‑segment elevation myocardial infarction (NSTEMI).

Methods. The study included 176 elderly patients who had suffered a non‑ST‑segment elevation myocardial infarction (NSTEMI) six months prior. Inclusion criteria: age: 60–74 years; NSTEMI occurred six months earlier; CHF with moderately reduced left ventricular ejection fraction at the time of hospital discharge. Examination procedures included: echocardiography; blood tests (complete blood count, biochemical analysis, levels of NT‑proBNP, C‑reactive protein, and sST2); calculation of inflammatory indices from the complete blood count: NLR (neutrophil‑to‑lymphocyte ratio); MLR (monocyte‑to‑lymphocyte ratio); SII (systemic inflammation index); SIRI (systemic inflammatory response index). The sST2 level was determined using the ELISA method (The RayBio® Human IL‑1 R4/ST2 ELISA kit, USA) according to the manufacturer’s protocol. Statistical analysis was performed using StatTech v.4.9.5 (Russia).

Results. The best prognostic indicators were demonstrated by: high‑sensitivity C‑reactive protein (hs‑CRP) (AUC = 0.848, p < 0.001); NLR index (AUC = 0.802, p < 0.001). This was followed by the SIRI index (AUC = 0.774, p < 0.001). Furthermore, a comparison of the two patient groups showed a significant association between elevated levels of sST2 and inflammatory markers and the development of CHF, depending on the left ventricular ejection fraction.

Conclusion. In elderly patients with myocardial infarction without ST elevation and initially moderately low EF (41–49%), the level of sST-2 ≥ 31.00 ng/l 6 months after the infarction was significantly higher in the absence of restoration of myocardial contractility than with normalization of the ejection fraction. NLR and SIRI indexes have the highest discrimination ability. A comprehensive assessment of sST-2, NLR/SIRI, and clinical factors allows stratification of patients to enhance personalized therapy and control.

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