Abstract 3390: The Value of Soluble ST2 Measurement for the Diagnostic and Prognostic Evaluation of Patients with Acute Dyspnea
Background: Concentrations of the interleukin-1 receptor family member, ST2, may be elevated in a prognostically meaningful fashion in patients with heart failure (HF), but the potential diagnostic and prognostic utility of ST2 measurement in dyspneic patients remains unknown.
Methods: 593 dyspneic patients with and without acute destabilized HF presenting to an emergency department were evaluated with measurements of ST2 concentrations. Bootstrapping followed by multivariate analyses identified independent predictors of either a diagnosis of acute HF or death at one year.
Results: Concentrations of ST2 were higher among those with acute HF (n=208) compared to those without (0.50 vs 0.15 ng/ml; p<0.001), and in multivariable analyses an ST2 concentration ≥0.20 ng/ml was an independent predictor of acute HF (Odds ratio [OR]= 3.8, 95% confidence intervals [CI]= 2.1–6.8; p<0.001). Median ST2 values at presentation to the emergency department were higher among decedents than survivors at one year (1.08 vs 0.18 ng/ml; p<0.001), and in multivariable analyses, an ST2 concentration ≥0.20 ng/ml was the strongest predictor of death at one year (Hazard ratio=5.6, 95% CI=2.2–14.2; p<0.001), independent of a diagnosis of acute HF, and superior to natriuretic peptide testing for prognosis estimation. Kaplan-Meier curves for all 593 subjects (Figure⇓) demonstrated the high rates of death associated with an elevated ST2 appeared early and were sustained out to a full year after presentation (log-rank p value <0.001).
Conclusions: Measurement of ST2 is promising for the diagnostic and prognostic evaluation of the patient with dyspnea.