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

Michele Emdin, Alberto Aimo, Giuseppe Vergaro, Antoni Bayes-Genis, Josep Lupón, Roberto Latini, Jennifer Meessen, Inder S. Anand, Jay N. Cohn, Jørgen Gravning, Lars Gullestad, Kaspar Broch, Thor Ueland, Ståle H. Nymo, Hans Peter Brunner-La Rocca, Rudolf A. de Boer, Hanna K. Gaggin, Andrea Ripoli, Claudio Passino, James L. Januzzi

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25 Scopus citations

Abstract

Background: Soluble suppression of tumorigenesis-2 (sST2) is a biomarker related to inflammation and fibrosis. Objectives: This study assessed the independent prognostic value of sST2 in chronic heart failure (HF). Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)2309-2320
Number of pages12
JournalJournal of the American College of Cardiology
Volume72
Issue number19
DOIs
StatePublished - Nov 6 2018

Keywords

  • NT-proBNP
  • heart failure
  • prognosis
  • sST2
  • troponin T

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    Emdin, M., Aimo, A., Vergaro, G., Bayes-Genis, A., Lupón, J., Latini, R., Meessen, J., Anand, I. S., Cohn, J. N., Gravning, J., Gullestad, L., Broch, K., Ueland, T., Nymo, S. H., Brunner-La Rocca, H. P., de Boer, R. A., Gaggin, H. K., Ripoli, A., Passino, C., & Januzzi, J. L. (2018). sST2 Predicts Outcome in Chronic Heart Failure Beyond NT−proBNP and High-Sensitivity Troponin T. Journal of the American College of Cardiology, 72(19), 2309-2320. https://doi.org/10.1016/j.jacc.2018.08.2165