Elsevier

American Heart Journal

Volume 244, February 2022, Pages 66-76
American Heart Journal

Clinical Investigations
Novel plasma biomarkers predicting biventricular involvement in arrhythmogenic right ventricular cardiomyopathy

https://doi.org/10.1016/j.ahj.2021.10.187Get rights and content
Under a Creative Commons license
open access

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease characterized by fibrofatty replacement of the myocardium and ventricular arrhythmias. Biventricular involvement in ARVC may lead to heart failure. This study aimed to investigate the role of plasma biomarkers soluble (s)ST2, Galectin-3 (Gal-3) and GDF-15 in predicting biventricular involvement and adverse outcomes in ARVC.

Methods and Results

ARVC patients from 2 independent cohorts, were studied. The Bejing (Chinese) cohort (n = 108) was the discovery cohort, whereas the Zurich (Swiss) cohort (n = 47) served as validation. All patients had a definite ARVC diagnosis at time of blood withdrawal. Biomarkers were independently correlated with NT-proBNP and left ventricular (LV)-function. ARVC patients with LV involvement had higher levels of sST2 and GDF-15 as compared to controls and patients with isolated right ventricle (RV) involvement. sST2 and GDF-15 were significantly correlated with late gadolinium enhancement in CMR and with adverse heart failure outcomes. Gal-3 was elevated in ARVC patients with and without LV involvement. The combined use of the three biomarkers (sST2, GDF-15 and NT-proBNP) showed the best performance in predicting LV involvement in both cohorts. Plasma drawn from the coronary arteries and coronary sinus indicated a transmyocardial elevation of sST2, but no transmyocardial gradient of GDF-15. After heart transplantation, both sST2 and GDF-15 returned to near-normal levels.

Conclusion

Our study showed that sST2 and GDF-15 may predict biventricular involvement in ARVC. The combined use of sST2, GDF-15 and NT-proBNP showed the best prediction of biventricular involvement in ARVC.

Graphical abstractAU: Please provide the all author(s) degree. Novel biomarkers in ARVC, Plasma levels of sST2 and GDF-15 are elevated in ARVC patients with biventricular (BiV) involvement and these biomarkers are correlated with adverse heart failure outcomes, whereas Gal-3 levels are elevated in patients with and without BiV involvement. The combined use of sST2, GDF-15 and NT-proBNP showed the best prediction of BiV involvement in ARVC.

Graphical abstract

Novel biomarkers in ARVC, Plasma levels of sST2 and GDF-15 are elevated in ARVC patients with biventricular (BiV) involvement and these biomarkers are correlated with adverse heart failure outcomes, whereas Gal-3 levels are elevated in patients with and without BiV involvement. The combined use of sST2, GDF-15 and NT-proBNP showed the best prediction of BiV involvement in ARVC.

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Keywords

Arrhythmogenic cardiomyopathy
Right ventricular
Biomarker
Heart failure
Risk stratification

Cited by (0)

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Deniz Akdis and Liang Chen are shared first authors

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Firat Duru and Jiangping Song are shared senior authors