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Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic
Domingo A Pascual-Figal1, Jordi Ordoñez-Llanos, Pedro L Tornel
1Cardiology Service, Virgen de la Arrixaca Hospital and Department of Medicine, University of Murcia, Murcia 30120, Spain. dapascual@servicam.com
Insights
Elevated soluble ST2 (sST2) levels predict sudden cardiac death (SCD) in heart failure (HF) patients. Combining sST2 with NT-proBNP improves risk prediction for SCD in chronic HF.
Area of Science:
- Cardiology
- Biomarker Research
- Heart Failure Management
Background:
- Sudden cardiac death (SCD) prediction is challenging in chronic heart failure (HF).
- Elevated soluble ST2 (sST2) levels correlate with poor outcomes in acute HF.
- The prognostic role of sST2 in SCD is not well-established.
Purpose of the Study:
- To investigate if soluble ST2 (sST2) measurement can identify heart failure (HF) patients at risk for sudden cardiac death (SCD).
Main Methods:
- A nested case-control study within the MUSIC registry.
- Included 36 SCD cases and 63 matched controls from ambulatory HF patients (NYHA class II-III, LVEF ≤45%).
- Collected demographic, clinical, echocardiographic, electrical, and biochemical data.
Main Results:
- sST2 concentrations were significantly higher in SCD cases (0.23 ng/ml) versus controls (0.12 ng/ml).
- sST2 predicted SCD risk (OR: 1.39, 95% CI: 1.09-1.78).
- Combined sST2 and NT-proBNP improved SCD risk stratification, with 71% of patients with both biomarkers elevated experiencing SCD.
Conclusions:
- Elevated sST2 levels are predictive of SCD in chronic HF patients.
- sST2 provides complementary information to NT-proBNP for risk assessment.
- A combined biomarker approach may enhance clinical decision-making for SCD risk in HF.
Objectives:
We studied whether the measurement of the soluble form of ST2 (sST2), an interleukin-1 receptor family member, could identify heart failure (HF) patients at risk of sudden cardiac death (SCD).
Background:
The prediction of SCD remains an important challenge in patients with mild-to-moderate chronic HF. Concentrations of sST2 have been found increased and related to worse long-term outcomes in patients with acute HF. Whether sST2 has a prognostic role in SCD is unknown.
Methods:
A nested case-control study was performed on 36 cases of SCD and 63 control patients (matched for age, sex, and left ventricular ejection fraction) obtained from the MUSIC (MUerte Súbita en Insuficiencia Cardíaca) registry, a 3-year multicenter registry of ambulatory HF patients (New York Heart Association functional class II to III, left ventricular ejection fraction < or =45%). Demographic, clinical, echocardiographic, electrical, and biochemical data were collected at enrollment.
Results:
Concentrations of sST2 were greater among decedents (0.23 ng/ml [interquartile range 0.16 to 0.43 ng/ml] vs. 0.12 ng/ml [interquartile range 0.06 to 0.23 ng/ml], p = 0.001) and were predictive of experiencing SCD (+0.1 ng/ml, odds ratio: 1.39, 95% confidence interval: 1.09 to 1.78, p = 0.006). On the basis of a combined biomarker status, only 4% of patients experienced SCD for neither sST2 nor N-terminal pro-B-type natriuretic peptide (NT-proBNP) above receiver-operator characteristic-derived cut-off points (0.15 ng/ml and 2,000 ng/l, respectively), 34% for either biomarker above, and 71% for both biomarkers above (p < 0.001 for trend). This combined variable added incremental prognostic value to the multivariable regression model (p < 0.001).
Conclusions:
Elevated sST2 concentrations are predictive of SCD in patients with chronic HF and provide complementary information to NT-proBNP levels. A combined biomarker approach may have an impact on clinical decision-making.
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