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Soluble ST 2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community ‐ Dwelling Population

View Article: PubMed Central - PubMed

ABSTRACT

Background: Soluble ST2 (sST2), a marker of myocyte stretch and fibrosis, has prognostic value in many cardiovascular diseases. We hypothesized that sST2 levels are associated with incident heart failure (HF), including subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fraction, and cardiovascular death.

Methods and results: Baseline serum sST2 was measured in 3915 older, community‐dwelling subjects from the Cardiovascular Health Study without prevalent HF. sST2 levels were associated with older age, male sex, black race, traditional cardiovascular risk factors, other biomarkers of inflammation, cardiac stretch, myocardial injury, and fibrosis, and abnormal echocardiographic parameters. In longitudinal analysis, greater sST2 was associated with a higher risk of incident HF and cardiovascular death; however, in multivariate models adjusting for other cardiac risk factors and the cardiac‐specific biomarker, N‐terminal pro–type B natriuretic peptide, these associations were attenuated. In these models, an sST2 level above the US Food and Drug Administration–approved cut‐off value (>35 ng/mL) was significantly associated with incident HF (hazard ratio [HR], 1.20; 95% CI, 1.02–1.43) and cardiovascular death (HR, 1.21; 95% CI, 1.02–1.44), and greater sST2 was continuously associated with cardiovascular death (per 1‐ln increment: HR, 1.24; 95% CI, 1.02–1.50). sST2 was not associated with the HF subtypes of HFpEF and HFrEF in adjusted analysis. Addition of sST2 to existing risk models of HF and cardiovascular death modestly improved discrimination and reclassification into a higher risk.

Conclusions: The predictive value of sST2 for HF of all subtypes and cardiovascular death is modest in an elderly population despite strong cross‐sectional associations with risk factors and underlying cardiac pathology.

No MeSH data available.


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Study flow diagram. HF indicates heart failure.
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jah31677-fig-0001: Study flow diagram. HF indicates heart failure.

Mentions: We performed a longitudinal observational study utilizing stored serum samples from the multicenter Cardiovascular Health Study (CHS). Details of the design and methods of the CHS have been published previously.26 Briefly, study participants included community‐dwelling adults ≥65 years enrolled at 4 participating centers. Participants (N=5201) initially enrolled in 1989–1990, and an black supplemental cohort (N=687) enrolled in 1992–1993. This ancillary analysis included participants without a previous diagnosis of HF in whom measures of amino terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T (hs‐cTnT) had already been performed as previously described27, 28 and with available stored serum for measurement of sST2. Figure 1 is a flow diagram of CHS participants who met criteria or were excluded for the present sST2 analysis. The CHS was approved by the institutional review boards of the University of Washington (Seattle, WA) and participating centers. The present analysis was approved by the University of Maryland Baltimore Institutional Review Board (Baltimore, MD). All participants gave written informed consent.


Soluble ST 2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community ‐ Dwelling Population
Study flow diagram. HF indicates heart failure.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015272&req=5

jah31677-fig-0001: Study flow diagram. HF indicates heart failure.
Mentions: We performed a longitudinal observational study utilizing stored serum samples from the multicenter Cardiovascular Health Study (CHS). Details of the design and methods of the CHS have been published previously.26 Briefly, study participants included community‐dwelling adults ≥65 years enrolled at 4 participating centers. Participants (N=5201) initially enrolled in 1989–1990, and an black supplemental cohort (N=687) enrolled in 1992–1993. This ancillary analysis included participants without a previous diagnosis of HF in whom measures of amino terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T (hs‐cTnT) had already been performed as previously described27, 28 and with available stored serum for measurement of sST2. Figure 1 is a flow diagram of CHS participants who met criteria or were excluded for the present sST2 analysis. The CHS was approved by the institutional review boards of the University of Washington (Seattle, WA) and participating centers. The present analysis was approved by the University of Maryland Baltimore Institutional Review Board (Baltimore, MD). All participants gave written informed consent.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Soluble ST2 (sST2), a marker of myocyte stretch and fibrosis, has prognostic value in many cardiovascular diseases. We hypothesized that sST2 levels are associated with incident heart failure (HF), including subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fraction, and cardiovascular death.

Methods and results: Baseline serum sST2 was measured in 3915 older, community‐dwelling subjects from the Cardiovascular Health Study without prevalent HF. sST2 levels were associated with older age, male sex, black race, traditional cardiovascular risk factors, other biomarkers of inflammation, cardiac stretch, myocardial injury, and fibrosis, and abnormal echocardiographic parameters. In longitudinal analysis, greater sST2 was associated with a higher risk of incident HF and cardiovascular death; however, in multivariate models adjusting for other cardiac risk factors and the cardiac‐specific biomarker, N‐terminal pro–type B natriuretic peptide, these associations were attenuated. In these models, an sST2 level above the US Food and Drug Administration–approved cut‐off value (>35 ng/mL) was significantly associated with incident HF (hazard ratio [HR], 1.20; 95% CI, 1.02–1.43) and cardiovascular death (HR, 1.21; 95% CI, 1.02–1.44), and greater sST2 was continuously associated with cardiovascular death (per 1‐ln increment: HR, 1.24; 95% CI, 1.02–1.50). sST2 was not associated with the HF subtypes of HFpEF and HFrEF in adjusted analysis. Addition of sST2 to existing risk models of HF and cardiovascular death modestly improved discrimination and reclassification into a higher risk.

Conclusions: The predictive value of sST2 for HF of all subtypes and cardiovascular death is modest in an elderly population despite strong cross‐sectional associations with risk factors and underlying cardiac pathology.

No MeSH data available.


Related in: MedlinePlus