Pediatric heart failure is a rare but serious condition with a variety of underlying etiologies ranging from congenital heart disease to neuromuscular disorders. However, treatment of pediatric heart failure is hindered by the absence of biomarkers to monitor patient response to therapy or identify risk of progression.
According to the 2013 American College of Cardiology/American Heart Association guidelines, soluble ST2 (ST2) and galectin-3 (Gal3) are additive risk stratification biomarkers for acute and chronic heart failure in adults and show large promise at being used to adjust therapies and anticipate which patients need more aggressive treatment. Due to the rareness of biomarkers available in pediatric heart failure, Mayo Clinic researchers sought to provide a foundation for the use of ST2 and Gal3 in pediatric patients by assessing values of these biomarkers among children without heart failure. The study was recently published in the journal Clinical Biochemistry.
While management of heart failure among adults has improved rapidly in recent years due in large part to the use of biomarkers, there is still room for improvement. This is especially the case for pediatric patients, as they have not seen the same benefit from biomarkers.
“We reached out to our clinical colleagues and asked if they did or didn’t use biomarkers in their practice and why or why not. The repeated response was a lack of data on what to do with a given result. We could give a number and the normal range among healthy adults, but there was no way to know if the patient result was abnormal or simply a factor of age,” said Jeff Meeusen, Ph.D., a Consultant in the Cardiovascular Laboratory Medicine Group at Mayo Clinic and author on the paper.
To enhance the ability to effectively identify risk or monitor response to therapy in pediatric patients without heart failure, researchers evaluated ST2 and Gal3 in children being seen at Mayo Clinic for other non-heart-disease-relatedconditions.
“Most normal-values studies only test healthy normal subjects, however, normal healthy children are rarely hospitalized. Working with the Mayo Clinic Biospecimen Donor Program, we recruited Mayo Clinic pediatric patients to provide more clinically applicable results,” said Dr. Meeusen. The Mayo Clinic Biospecimen Donor Program collects samples and health information donated by Mayo Clinic patients and other volunteers regardless of health history.
Upon completion of the study, researchers identified a trend for increased ST2 values with increased age among males but not females. This finding is in agreement with similar studies in adults; however, the physiological reasons and clinical relevance of gender-specific differences remain to be determined. Galectin-3 values were not influenced by age or gender.
“Based on these results, the reference range we established can be used by pediatricians when managing patients with heart failure. It is our hope that this study will enable clinicians to more confidently order and interpret ST2 and Gal3,” added Dr. Meeusen.