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The integrated value of sST2 and global longitudinal strain in the early stratification of patients with severe aortic valve stenosis: a translational imaging approach

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Abstract

Aortic valve stenosis (AVS) is associated with significant myocardial fibrosis (MF). Global longitudinal strain (GLS) is a sensible indicator of systolic dysfunction. ST2 is a member of the interleukin (IL)-1 receptor family and a modulator of hypertrophic and fibrotic responses. We aimed at assessing: (a) the association between adverse LV remodeling, LV functional parameters (including GLS) and sST2 level. (b) The association between MF (detected by endo-myocardial biopsy) and sST2 in patients with AVS undergoing surgical valve replacement. Twenty-two patients with severe AVS and preserved EF underwent aortic valve replacement. They performed laboratory analysis, including serum ST2 (sST2), echocardiography and inter-ventricular septum biopsy to assess MF (%). We included ten controls for comparison. Compared to controls, patients showed higher sST2 levels (p < 0.0001). sST2 showed correlation with Age (r = 0.58; p = 0.0004), E/e′ average (r = 0.58; p = 0.0007), GLS (r = 0.61; p = 0.0002), LAVi (r = 0.51; p = 0.003), LVMi (r = 0.43; p = 0.01), sPAP (r = 0.36; p = 0.04) and SVi (r = −0.47; p < 0.005). No correlation was found between MF and sST2. At ROC analysis, a sST2 ≥ 284 ng/mL had the best accuracy to discriminate controls from patients with impaired GLS, i.e. GLS ≤ 17% (AUC 0.80; p = 0.003; sensitivity 95%; specificity 83%) and increased E/e′ average (AUC 0.87; p = 0.0001; sensitivity 96%; specificity 74%). At multivariate regression analysis GLS resulted the only independent predictor of sST2 levels (R2 = 0.35; p =  0.0004). Patients with severe AVS present elevated sST2 levels. LV GLS resulted the only independent predictor of sST2 levels.

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Abbreviations

AVA/AVAi:

Aortic valve area/indexed

AVS:

Aortic valve stenosis

BNP:

Brain natriuretic peptide

E/A:

Ratio of proto-diastolic E wave pulsed Doppler velocity to end-diastolic A wave

E/e′:

Ratio of protodiastolic E wave pulsed Doppler velocity to tissue Doppler proto-diastolic velocity

EF:

Ejection fraction

GLS:

Global longitudinal strain

iEDP:

Invasive end-diastolic pressure

IL:

Interleukin

LAVi:

Indexed left atrial volume

LV:

Left ventricular

LVMi:

Indexed left ventricular mass

MF:

Myocardial fibrosis

MRI:

Magnetic resonance imaging

ROI:

Region of interest

sPAP:

Systolic pulmonary artery pressure

STE:

Speckle tracking echocardiography

SVi:

Indexed stroke volume

TDI:

Tissue Doppler imaging

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Funding

Blood assays performed using PRA (Progetti Ricerca Ateneo-Università di Pisa) 2016 funding.

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Authors and Affiliations

  1. Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy

    Iacopo Fabiani, Lorenzo Conte, Nicola Riccardo Pugliese, Enrico Calogero, Valentina Barletta, Rossella Di Stefano, Tatiana Santoni, Uberto Bortolotti, Anna Sonia Petronio & Vitantonio Di Bello

  2. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100, Pisa, Italy

    Cristian Scatena & Antonio Giuseppe Naccarato

Authors
  1. Iacopo Fabiani
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  2. Lorenzo Conte
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  3. Nicola Riccardo Pugliese
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  4. Enrico Calogero
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  5. Valentina Barletta
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  6. Rossella Di Stefano
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  7. Tatiana Santoni
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  8. Cristian Scatena
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  9. Uberto Bortolotti
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  10. Antonio Giuseppe Naccarato
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  11. Anna Sonia Petronio
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  12. Vitantonio Di Bello
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Corresponding author

Correspondence to Enrico Calogero.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5).

Informed consent

Informed consent was obtained from all patients for being included in the study.

Research involving human and animal rights

No animal studies were carried out by the authors for this article.

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Fabiani, I., Conte, L., Pugliese, N.R. et al. The integrated value of sST2 and global longitudinal strain in the early stratification of patients with severe aortic valve stenosis: a translational imaging approach. Int J Cardiovasc Imaging 33, 1915–1920 (2017). https://doi.org/10.1007/s10554-017-1203-2

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  • DOI: https://doi.org/10.1007/s10554-017-1203-2

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