Helps guide clinicians to risk-stratify patients, identify HF patients at risk for CV death and rehospitalization
A RENOWNED cardiologist from the United States told a local audience of key opinion leaders and practicing cardiologists that a new test for heart failure (HF) can help the clinician identify patients at high risk of cardiovascular death, and/or being rehospitalized due to HF. The test can also guide the physician on any change or adjustment needed in the patient’s prescribed drug regimen.
The prognostic value and clinical utility of the novel test was explained by Prof. Alan Maisel, MD, a professor of Medicine at the University of California (San Diego), during a forum at the Makati Shangri La hotel last March 20.
This diagnostic and prognostic breakthrough is considered significant, especially with the global trend indicating aging of the various populations including the Philippines, which is likely to increase the prevalence of HF.
HF is considered a major clinical and public health challenge, wrongly diagnosed in some instances, according to Dr. Maisel, who is also the director of the Coronary Care Unit and Heart Failure Program of the Veterans Affairs San Diego Healthcare System
In the Philippines, there are no available statistics on HF, and an ongoing study currently being done by the Philippine Heart Association (PHA) as part of the National Nutrition and Health Survey (NNHeS) is expected to give a better picture of the burden of HF in the country.
However, considering that cardiovascular disease remains the leading cause of deaths in the Philippines accounting for almost one-third (31.8 percent) of all deaths, it is projected that the prevalence of HF is also high with an estimated 1.8 million of the population suffering from it.
Unfortunately, many cases of HF remain undiagnosed, delaying appropriate treatment. Early identification of patients at risk for HF, especially those who may still have no symptoms but with structural heart disease s that predispose them to HF is critical in order to significantly reduce the hospitalization and death toll and consequent economic burden of HF in the country and worldwide.
Heart experts are one in sounding the alarm for a more aggressive and reliable approach in the early diagnosis of HF, considering that deaths due to it exceed the combined death rate for lung, breast, prostate, and pancreatic cancer, and HIV.
It is also the leading cause for hospitalization in the United States, with a poor outcome after hospitalization. Studies show a 90-day risk of death of 15 percent and a 30-percent likelihood of being readmitted to the hospital.
One of the breakthroughs in the diagnosis of HF is the discovery of heart biomarkers such as the ST2 cardiac biomarker. The ST2 is a novel indicator of heart fibrosis due to a heart attack or worsening HF. It is a form of body protein, which is a member of the interleukin family; and there is now mounting scientific evidence published in peer-reviewed international journals that it can predict those who may be at risk to die due to HF.
In these studies, patients with ST2 levels above a clinical threshold (cutoff value of 35 ng/mL) consistently have a much higher risk of dying; while those with ST2 levels below the identified threshold have a very low risk of death. The ST2 level also correlates well with HF severity.
Prof. Maisel stressed that ST2 measurement can improve patient care. He recommended measuring it serially in some patients to get a better picture on how the patient is responding to treatment. Requesting it with other diagnostic biomarkers like the brain natriuretic peptides (BNP) or NT-proBNP, can give the clinician additional information which can guide him on how to better manage HF patients.
The test is not unfavorably influenced by age of patient, impaired kidney function or increased body mass index (in overweight or obese individuals) , all of which are limiting factors for other diagnostic biomarker tests for HF.
ST2, which is measured by an immunoassay method, is available as Presage ST2 Assay, manufactured by Critical Diagnostics of San Diego, California. It has been approved by the Food and Drug Administration (FDA), and carries a CE (Conformité Européenne) Mark.
PROF. ALAN MAISEL explains to doctors and the media in another round-table discussion the clinical utility of the ST2 cardiac biomarker in identifying patients with heart failure who are at risk of succumbing to a cardiovascular death and being rehospitalized due to heart failure. To his left is Dr. Dante Morales, senior vice-president for medical