CARDIOLOGIST Dr. Alan Maisel has seen the worst—and probably the best—through a lifetime of medical practice, but the one that really lingers, and which he brought up over a recent lunch with the press, was the story of a patient whose life he could have saved.
“A man who was about 65 came in the coronary care unit and initially complained of having had progressive shortness of breath for several weeks,” he began.
Upon close examination, a heart failure was later diagnosed. His BMP shot up to about 800 (from his normal 300) and his ST2 was 80, which was 45 notches higher than the standard 35.
“The hospital staff gave him the water-pills medicine, and his BMP went down to 300 after three days. But his ST2 didn’t drop to 35—it dropped only to 65,” Dr. Maisel continued. “I was really afraid to send him home, but the doctors got rid of him saying the BMP was really good.
“I came to work days later and looked up his medical record, and I learned that he died over the weekend,” Dr. Maisel said. “He was looking good, feeling good, he had a normal BMP level—but he had high ST2.”
This story is yet another addendum to the grim statistics of 38 million people around the world who die from heart failure every year, a lot of which cases go either unchecked or misdiagnosed.
According to the Mayo Clinic, “Heart failure often develops after other conditions [coronary artery disease and heart attack, hypertension, faulty heart valves, damage to the heart muscle, myocarditis and chronic diseases, among others] have damaged or weakened your heart. However, the heart doesn’t need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff. “In heart failure, the main pumping chambers of your heart [the ventricles] may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch [dilate] to the point that the heart can’t pump blood efficiently throughout your body. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.”
Said Dr. Maisel, “We are in an epidemic of heart failure, especially with [the prevalence of] obesity and Type 2 diabetes, and yet we spend more resources screening for cancer than we do for heart failure. This is probably a paradigm that needs to change.”
One of the reasons cancer is given more resources, Dr. Maisel said, is that there are more biomarkers that can be flagged during screening. In heart failure, doctors only had one biomarker to be on the lookout for. Just one—until recently, that is. Now, another biomarker has been identified: the ST2, a cardiac biomarker that reflects heart stress caused by aggravated heart failure. It is a form of body protein that can predict a heart failure patient’s odds of dying.
While it sounds creepy and straight out of a sci-fi movie involving some mad man’s quest to be immortal, an ST2 test, Dr. Maisel said, is something as simple as a blood test, although it costs much more than the standard-issue test.
“The discovery of ST2 came from a laboratory in Boston, where scientists put some heart cells on a petri dish. They put a lot of stress on the heart, which led to fibrosis,” Dr. Maisel explained. “As the heart begins to fail, it sheds what we call a soluble ST2. This is what we measure.”
Patients with consistent ST2 levels above the clinical threshold of 35 nanograms per milliliter have severe heart failure and a higher risk of sudden death. In the Philippines the Presage ST2 Assay, the test for ST2, is exclusively distributed and marketed by Unilab, the leading pharmaceutical and health-care company in the country. Obviously, the hope that comes with this breakthrough on ST2 is that doctors can now do more for heart-failure patients who otherwise don’t show outward signs of imminent death.