Association of ST2 levels with cardiac structure and function and mortality in outpatients
Lori B Daniels1, Paul Clopton, Navaid Iqbal
1Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, CA, USA. lbdaniels@ucsd.edu
Insights
Soluble ST2 (ST2) levels predict mortality in outpatients undergoing echocardiograms. Elevated ST2 indicates higher risk, especially when combined with B-type natriuretic peptide, highlighting ST2’s prognostic value.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- ST2, an interleukin-1 receptor family member, is elevated with cardiomyocyte strain.
- ST2 has known prognostic value in acute and chronic heart failure patients.
- The prognostic utility of ST2 in outpatients is not well-established.
Purpose of the Study:
- To investigate the clinical and echocardiographic correlates of ST2 levels in outpatients.
- To evaluate the prognostic significance of ST2 in predicting mortality in this population.
Main Methods:
- Measured ST2 levels in 588 outpatients referred for echocardiograms.
- Analyzed subjects by ST2 quartiles and an optimal cut-point (28.25 ng/mL).
- Assessed all-cause death at 1 year as the primary outcome.
Main Results:
- Heart rate, creatinine clearance, diuretic use, and right ventricular hypokinesis were associated with ST2 levels.
- High ST2 levels independently predicted increased 1-year mortality (adjusted HR 2.5, P = .02).
- Combined elevated ST2 and B-type natriuretic peptide significantly increased mortality risk (adjusted HR 4.3, P = .01).
Conclusions:
- ST2 levels reflect right-sided heart function and predict 1-year mortality in outpatients.
- The identified optimal ST2 cut-point aligns with previous findings in sicker patient groups.
- ST2 emerges as a potent prognostic marker for short-term mortality risk in outpatients.
Background:
ST2, an interleukin-1 receptor family member up-regulated in the setting of cardiomyocyte strain, has prognostic value in patients with acute myocardial infarction, chronic severe heart failure, and acute heart failure. The predictive value of ST2 levels in outpatients is unknown. We studied the clinical and echocardiographic correlates of ST2 levels and evaluated their prognostic use in outpatients referred for echocardiograms.
Methods:
ST2 levels were measured in 588 outpatients referred for echocardiogram. Subjects were analyzed by quartile as well as by optimal ST2 cut-point (28.25 ng/mL) derived from receiver operating characteristic curve analysis. All-cause death at 1 year was the primary outcome.
Results:
In this cohort with mean age of 68 ± 12 years and median ST2 level of 19.8 ng/mL (interquartile range 15.8-23.7), 25 deaths occurred. Heart rate, creatinine clearance, use of diuretics, and the presence of right ventricular hypokinesis were independently associated with ST2 levels. At 6 months, no patients with ST2 below the median had died. Patients with high ST2 levels had an increased risk of death (adjusted hazard ratio [HR] 2.5, P = .02); those with elevated levels of both ST2 and B-type natriuretic peptide were at even higher risk (adjusted HR 4.3, P = .01 vs none elevated).
Conclusions:
ST2 levels reflect right-side heart size and function and are independent predictors of 1-year mortality in outpatients referred for echocardiograms. The optimal cut-point derived in this cohort is comparable with the previously identified prognostic cut-point for sicker patients. ST2 may be an especially strong prognostic marker for short-term mortality risk.
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