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10.3390/jcm14103496
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy

by
Matteo Beltrami
1,*,
Alessandro Galluzzo
2,
Giacomo Bonacchi
3,
Luca Checchi
1,
Giuseppe Ricciardi
1,
Laura Perrotta
1,
Manuel Garofalo
1,4,
Alessandro Paoletti Perini
5,
Alessio Mattesini
6,
Paolo Pieragnoli
1 and
Alberto Palazzuoli
7
1
Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy
2
Cardiology Unit, Rivoli Hospital, 10098 Turin, Italy
3
Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
4
School of Human Health Sciences, University of Florence, 50134 Florence, Italy
5
Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, 50134 Florence, Italy
6
Department of Structural Interventional Cardiology, Careggi University Hospital, 50134 Florence, Italy
7
Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, 53100 Siena, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(10), 3496; https://doi.org/10.3390/jcm14103496
Submission received: 12 March 2025 / Revised: 26 April 2025 / Accepted: 13 May 2025 / Published: 16 May 2025
(This article belongs to the Special Issue Clinical Diagnostics and Therapeutics Advances in Acute and Chronic Heart Failure)
Versions Notes

Abstract

Purpose: Although biomarkers of myocardial fibrosis and inflammation have been proposed as potential modulators of response to cardiac resynchronization therapy (CRT), their clinical utility and interaction with echocardiographic parameters remain incompletely understood. This study aims to assess the dynamic changes in these biomarkers, their relationship with echocardiographic variables, and their association with structural response to CRT. Methods: We retrospectively evaluated 86 consecutive patients referred for CRT with symptomatic heart failure, left ventricular (LV) ejection fraction ≤ 35%, QRS width ≥ 130 ms and LBBB morphology. We measured sST-2, Gal-3, NTpro-BNP and eGFR at baseline and after 1 year of CRT. An echocardiographic reduction of LV end-systolic volume ≥ 15% was used to define a patient as a responder to CRT. Results: The mean baseline and follow-up values of Gal-3 (responders: 24.1 [16.8;32] ng/mL, non-responders: 30 [20;39.3] ng/mL, p = 0.03) and sST2 (responders: 28.5 [20;36] ng/mL, non-responders: 34.5 [25;37.7] ng/mL, p = 0.03) were lower in responders than non-responders. Responders showed a significant reduction between baseline and follow-up values of ΔGal-3 (−12.1% vs. −2.5%, p = 0.04), ΔsST2 (−30.8% vs. 2.2%, p < 0.001), ΔNT-proBNP (−16.4% vs. 5.2, p = 0.04) and ΔeGFR (6.7 ± 24.3% vs. -6.3 ± 27.9%, p = 0.03). At the multivariate analyses, baseline Gal-3 [cut-off: 38.5 ng/mL, AUC: 0.63, p = 0.03, (OR 7.13 [1.12;45.41], p = 0.03), together with TAPSE > 17.5 mm (OR 10.86 [3.15;37.44], p < 0.001) significantly correlated with the structural response to CRT in several prediction models. Among echocardiographic parameters, TAPSE remained the strongest predictive factor of positive response to CRT at the univariate and multivariate analyses. Conclusions: In patients with heart failure and reduced ejection fraction undergoing CRT, Gal-3 and TAPSE are significantly associated with a positive structural response to CRT.
Keywords: cardiac resynchronization therapy; galectin-3; soluble suppression of tumorigenicity-2; heart failure with reduced ejection fraction; biomarkers cardiac resynchronization therapy; galectin-3; soluble suppression of tumorigenicity-2; heart failure with reduced ejection fraction; biomarkers

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MDPI and ACS Style

Beltrami, M.; Galluzzo, A.; Bonacchi, G.; Checchi, L.; Ricciardi, G.; Perrotta, L.; Garofalo, M.; Paoletti Perini, A.; Mattesini, A.; Pieragnoli, P.; et al. Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy. J. Clin. Med. 2025, 14, 3496. https://doi.org/10.3390/jcm14103496

AMA Style

Beltrami M, Galluzzo A, Bonacchi G, Checchi L, Ricciardi G, Perrotta L, Garofalo M, Paoletti Perini A, Mattesini A, Pieragnoli P, et al. Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy. Journal of Clinical Medicine. 2025; 14(10):3496. https://doi.org/10.3390/jcm14103496

Chicago/Turabian Style

Beltrami, Matteo, Alessandro Galluzzo, Giacomo Bonacchi, Luca Checchi, Giuseppe Ricciardi, Laura Perrotta, Manuel Garofalo, Alessandro Paoletti Perini, Alessio Mattesini, Paolo Pieragnoli, and et al. 2025. "Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy" Journal of Clinical Medicine 14, no. 10: 3496. https://doi.org/10.3390/jcm14103496

APA Style

Beltrami, M., Galluzzo, A., Bonacchi, G., Checchi, L., Ricciardi, G., Perrotta, L., Garofalo, M., Paoletti Perini, A., Mattesini, A., Pieragnoli, P., & Palazzuoli, A. (2025). Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy. Journal of Clinical Medicine, 14(10), 3496. https://doi.org/10.3390/jcm14103496

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