Clinical and prognostic significance of biomarker ratios in patients with heart failure and concomitant atrial fibrillation and diabetes mellitus

Background. Heart failure (HF) in combination with atrial fibrillation (AF) and diabetes mellitus (DM) significantly worsens the prognosis of patients, increasing the risk of rehospitali­zations and mortality. Biomarkers such as galectin-3, ST2, brain natriure­tic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with myocardial remodeling and inflammation. However, the prognostic significance of their ratios remains uncertain. The purpose was to eva­luate the predictive value of BNP, NT-proBNP, ST2, galectin-3, and their ratios in patients with HF, depending on the presence of AF and/or DM, regarding the risk of rehospitalizations and one-year mortality. Materials and methods. This prospective observational study included 398 patients (mean age 54.3 ± 7.2 years) hospitalized for decompensated HF. They were divided into four groups: HF with sinus rhythm (n = 122), HF with AF (n = 174), HF with DM (n = 50), and HF with both AF and DM (n = 52). Biomarkers were measured using enzyme-linked immunosorbent assay. The primary endpoints were rehospitalization and one-year mortality. Results. Patients with HF and DM had significantly higher levels of galectin-3 (+ 16.7 %, p = 0.003), NT-proBNP (+ 12.5 %, p = 0.015), and ST2 (+ 11.4 %, p = 0.002) compared to those without comorbidities. Individuals with HF, AF, and DM showed even higher NT-proBNP levels (+ 135.0 %, p = 0.0001) and increased NT-proBNP/BNP (+ 170.1 %, p = 0.0001), NT-proBNP/ST2 (+ 145.4 %, p = 0.0001), and NT-proBNP/galectin-3 ratios (+ 135.2 %, p = 0.0001). A reduced ST2/galectin-3 ratio was associated with poorer prognosis. The NT-proBNP/ST2 ratio was the strongest predictor of rehospitalizations (odds ratio 1.82, 95% confidence interval: 1.37–2.41, p = 0.0001). An elevation in ST2 > 41.81 ng/mL (p < 0.0001) and galectin-3 > 2.75 ng/mL (p = 0.0172) was associated with increased one-year mortality. Conclusions. The presence of AF and DM in HF patients is associated with elevated biomarker levels and higher risks of adverse effects. The NT-proBNP/ST2 ratio has significant prognostic value and may guide risk stratification in HF management.

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