ST2 in heart failure with preserved and reduced ejection fraction

Abstract

Objectives. Soluble suppression of tumorigenecity 2 (sST2) is prognostic in acute and chronic heart failure with reduced ejection fraction (HFrEF) but less studied in HF with preserved EF (HFpEF). We evaluated sST2 concentrations, correlations with biomarkers and echocardiographic measures of diastolic and systolic function, and associations with outcomes in HFpEF and HFrEF. Design and results. A total of 193 subjects from three different cohorts were included. Eighty-six HFpEF patients were obtained from the Karolinska Rennes (KaRen) study, 86 patients with HFrEF were recruited from referrals to Karolinska University Hospital for advanced assessment of HF, and 21 controls were included (ClinicalTrials.gov Identifier for KaRen: NCT01091467). HFrEF and controls cohorts did not have ClinicalTrials.gov registrations. sST2 was lower in HFpEF, median (interquartile range); 23 (17-31) compared to HFrEF; 35 (23-52) mg/L, p < .001. In both HFpEF and HFrEF, sST2 correlated positively with NT-proBNP (HFpEF r s ¼0.392, p < .001 and HFrEF r s ¼0.466, p < .001). In HFpEF, sST2 correlated to left atrial volume index (r s ¼0.276, p ¼ .019) but not to E/E, nor to left ventricular mass index. sST2 was in HFpEF associated with the composite endpoint of death or HF hospitalization, adjusted hazard ratio (HR) per log increase in sST2 6.62, 95% confidence interval (CI) 1.04-42.28, p ¼ .046, and in HFrEF death, heart transplant or left ventricular assist systems; 3.51, 95% CI 1.05-11.69, p ¼ .041. Conclusions. In patients with HFpEF compared to HFrEF, crude levels of sST2 were lower but potentially more strongly associated with outcomes. The lower levels of sST2 in HFpEF than in HFrEF may reflect lower degrees of fibrosis, but the potentially stronger association with outcomes may reflect a greater prognostic importance of progressive fibrosis and as such a greater potential for intervention. In conclusion; this study adds to the evidence of sST2 as prognostic marker in both HFpEF and HFrEF. ARTICLE HISTORY

Expression of the Novel Cardiac Biomarkers sST2, GDF-15, suPAR, and H-FABP in HFpEF Patients Compared to ICM, DCM, and Controls

“…However, contrary to our expectations, HFpEF patients evidenced low levels of sST2 similar to the control group. This finding also matches former studies, which reported lower levels of sST2 in HFpEF compared to HFrEF [28]. Further and bigger studies are required to verify these findings and help in explaining the underlying mechanisms of these results.…”

Peculiarities of chronic heart failure formation in patients with persistent atrial fi brillation depending on the renal dysfunction phenotype

“…Большой интерес представляет выявленная взаимосвязь NGAL и sST2, маркера, дополнительно использованного нами в качестве раннего и более точного диагностического признака ХСН. sST2 в ряде литературных источников рассматривается как независимый от функционального состояния почек маркер сердечной недостаточности, причем его диагностическая ценность велика как в отношении ХСН с сохраненной, так и сниженной ФВ ЛЖ [18]. Описана его независимая, ввиду экстракардиального происхождения, роль в активации провоспалительного механизма при формировании эндотелиальной дисфункции и миокардиального стресса в условиях коморбидности [19].…”

Soluble Suppression of Tumorigenicity 2: A Role in BiomarkerGuided Therapy of Heart Failure

“…Indeed, HF patients who were attained lowered levels of sST2 (<35ng/mL) and NT-proBNP (<1000 pg/mL) in contrast to those have haven higher levels of both biomarkers (≥35ng/mL and ≥1000 pg/mL, respectively) during treatment had been found improved survival and decreased need for re-admission [36,37] . In fact, multiple biomarker model based on both sST2 and NT-pro-BNP was able not just predict clinical outcomes during HF therapy, but yet to improve accuracy of prognostication for both HFpEF and HFrEF [38] . Although circulating levels of sST2 were predominantly associated with all-cause mortality and non-CV death in HF out-patients showing strong association with systemic inflammation and malnutrition, while NT-proBNP levels were associated with CV death and re-admission [39] , the combined use of both biomarkers for personifying optimization of HF care appears to be promising.…”