sST2 Predicts Outcome in Chronic Heart Failure Beyond NT−proBNP and High-Sensitivity Troponin T

• Published in: Journal of the American College of Cardiology Vol. 72; no. 19; pp. 2309 - 2320
• Main Authors: Emdin, Michele, Aimo, Alberto, Vergaro, Giuseppe, Bayes-Genis, Antoni, Lupón, Josep, Latini, Roberto, Meessen, Jennifer, Anand, Inder S., Cohn, Jay N., Gravning, Jørgen, Gullestad, Lars, Broch, Kaspar, Ueland, Thor, Nymo, Ståle H., Brunner-La Rocca, Hans-Peter, de Boer, Rudolf A., Gaggin, Hanna K., Ripoli, Andrea, Passino, Claudio, Januzzi, James L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 06.11.2018; Elsevier Limited
• Subjects: Age; Beta blockers; Biomarkers; Body mass index; Brain natriuretic peptide; Calcium-binding protein; Cardiology; Cardiovascular; Cardiovascular diseases; Death; Etiology; Fibrosis; Glomerular filtration rate; Heart diseases; Heart failure; Ischemia; Kidney diseases; Medical prognosis; Mortality; NT-proBNP; Patients; Peptides; prognosis; sST2; Studies; Troponin; Troponin T; Tumorigenesis; Ventricle; New York; United States > US; CHF; eGFR; heart failure; troponin T; NT-proBNP; LVEF; hs-TnT; sST2; prognosis; IL-33; estimated glomerular filtration rate; soluble suppression of tumorigenesis-2; high-sensitivity troponin T; chronic heart failure; interleukin-33; N-terminal pro−B-type natriuretic peptide; left ventricular ejection fraction
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2018.08.2165

Soluble suppression of tumorigenesis-2 (sST2) is a biomarker related to inflammation and fibrosis. This study assessed the independent prognostic value of sST2 in chronic heart failure (HF). Individual patient data from studies that assessed sST2 for risk prediction in chronic HF, together with N-terminal pro−B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT), were retrieved. A total of 4,268 patients were evaluated (median age 68 years, 75% males, 65% with ischemic HF, 87% with left ventricular ejection fraction [LVEF] <40%). NT-proBNP, hs-TnT, and sST2 were 1,360 ng/l (interquartile interval: 513 to 3,222 ng/l), 18 ng/l (interquartile interval: 9 to 33 ng/l), and 27 ng/l (interquartile interval: 20 to 39 ng/l), respectively. During a 2.4-year median follow-up, 1,319 patients (31%) experienced all-cause death (n = 932 [22%] for cardiovascular causes). Among the 4,118 patients (96%) with available data, 1,029 (24%) were hospitalized at least once for worsening HF over 2.2 years. The best sST2 cutoff for the prediction of all-cause and cardiovascular death and HF hospitalization was 28 ng/ml, with good performance at Kaplan-Meier analysis (log-rank: 117.6, 61.0, and 88.6, respectively; all p < 0.001). In a model that included age, sex, body mass index, ischemic etiology, LVEF, New York Heart Association functional class, glomerular filtration rate, HF medical therapy, NT-proBNP, and hs-TnT, the risk of all-cause death, cardiovascular death, and HF hospitalization increased by 26%, 25%, and 30%, respectively, per each doubling of sST2. sST2 retained its independent prognostic value across most population subgroups. sST2 yielded strong, independent predictive value for all-cause and cardiovascular mortality, and HF hospitalization in chronic HF, and deserves consideration to be part of a multimarker panel together with NT-proBNP and hs-TnT. [Display omitted]