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Serum-Soluble ST2 Is a Novel Biomarker for Evaluating Left Atrial Low-Voltage Zone in Paroxysmal Atrial Fibrillation

Zefeng Wang, Liting Cheng, Junmeng Zhang, Zhuo Liang, Ruiqing Dong, Fei Hang, Xinlu Wang, Ziyu Wang, Yongquan Wu, Jie Du

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)

Med Sci Monit 2020; 26:e926221

DOI: 10.12659/MSM.926221

Available online: 2020-07-10

Published: 2020-09-08

BACKGROUND: Paroxysmal atrial fibrillation (pAF) recurrence after radiofrequency catheter ablation (RFCA) is linked to low-voltage zone (LVZ). This study explored whether serum soluble ST2 (sST2) levels can predict the size of LVZs in patients with pAF.
MATERIAL AND METHODS: A total of 177 patients with pAF treated with RFCA were consecutively enrolled in this study. One hundred twenty-five patients (70.6%) with <20% LVZ were assigned to Group A, and 52 patients (29.4%) with a LVZ >20% were assigned to Group B. Levels of soluble ST2 (sST2), growth and differentiation factor (GDF-15) and tissue inhibitor of MMP1 (TIMP-1) were measured.
RESULTS: The sST2 levels were higher in Group B than in Group A (23.9±3.3 vs. 30.9±5.0 ng/mL, P<0.000). In multivariable logistic regression analysis, sST2 was the only independent parameter for predicting left atrial LVZ (odds ratio, 1.611 [1.379-1.882]; P<0.001). The cut-off value of sST2 obtained by receiver operating characteristic (ROC) analysis was 26.65 ng/mL for prediction of LVZ (sensitivity: 86.5%, specificity: 84.8%). The under-curve area was 0.895 (0.842-0.948) (P<0.001). At 12-month follow-up, patients with sST2 <26.65 ng/mL had more patients free from atrial arrhythmias compared to patients with sST2 >26.65 ng/mL (88.6% vs. 69.8%, P<0.01).
CONCLUSIONS: We demonstrated that sST2 levels are higher in pAF patients with LVZ >20% compared to those with a smaller LVZ. Also increased sST2 levels can serve as a novel predictor of AF recurrence rate in patients who have undergone RFCA.

Keywords: Atrial Fibrillation, Biological Markers, Catheter Ablation