Abstract 19376: High-Sensitivity ST2 for Prediction of Adverse Outcomes in Chronic Heart Failure
Background: Soluble ST2 reflects activity of an IL-33 dependent cardioprotective signaling axis and is a diagnostic and prognostic marker in acute heart failure. However, the use of ST2 in chronic heart failure has not been well defined. Our objective was to determine whether plasma levels of the soluble ST2 receptor predict adverse outcomes in chronic heart failure beyond currently used approaches.
Methods: In the largest study of ST2 to date, we determined the association between ST2 level and risk of death or transplantation in a multi-center prospective cohort of 1,141 outpatients with chronic heart failure. Adjusted Cox models, receiver operating characteristic (ROC) analyses, and risk reclassification metrics were used to assess the added value of ST2 in predicting risk beyond currently used prognostic factors.
Results: After a median of 2.8 years, 267 patients (23%) died or underwent heart transplantation. Patients in the highest ST2 tertile (ST2>36.3ng/ml) had a markedly increased risk of adverse outcomes compared to the lowest tertile (ST2≤22.3ng/ml), with an unadjusted hazard ratio (HR) of 3.5 (95%CI:2.4–5.0;P<0.001) that remained significant after multivariable adjustment (adjusted HR 1.9 [95%CI:1.3–2.8];P<0.001). In ROC analyses, the area under the curve (AUC) for ST2 was 0.74 (95%CI:0.69–0.79), and similar to NT-proBNP (AUC=0.77 [95%CI:0.72–0.81];P=0.24 versus ST2). Addition of ST2 to a risk panel comprised of NT-proBNP and the Seattle Heart Failure Model reclassified 15% of patients into more appropriate risk categories (P<0.01).
Conclusions: ST2 is a potent marker of risk in chronic heart failure and offers moderate improvement in assessing prognosis beyond natriuretic peptides and clinical risk scores.
- © 2010 by American Heart Association, Inc.