Soluble ST2, high-sensitivity troponin T- and N-terminal pro-B-type natriuretic peptide: complementary role for risk stratification in acutely decompensated heart failure

Abstract

AimTo investigate the use of biomarkers providing independent information regarding physiology in acutely decompensated heart failure (ADHF) for assessment of risk. Methods and resultsThis was a prospective study of 107 patients hospitalized with ADHF (mean age 72 + 13 years, 44% male, left ventricular ejection fraction 47 + 15%). Blood samples were collected on presentation to measure soluble (s)ST2, highsensitivity troponin T (hsTnT), and amino-terminal pro-B type natriuretic peptide (NT-proBNP) levels. Clinical follow-up was obtained for all patients over a median period of 739 days, and all-cause mortality was registered. Concentrations of sST2 [per 10 ng/mL, hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.04-1.13; P , 0.001], hsTnT (per 0.1 ng/mL, HR 1.16, 95% CI 1.09-1.24; P , 0.001), and NT-proBNP (per 100 pg/mL, HR 1.01, 95% CI 1.003-1.01; P , 0.001) were each predictive of a higher risk of death. In bootstrapped models, each biomarker retained independent predictive value for mortality. Patients with all three biomarkers below their optimal cut-off at presentation were free of death (0%) during follow-up, whereas 53% of those with elevations of all three biomarkers had died. For each elevated marker (from 0 to 3) adjusted analysis suggested a tripling of the risk of death (for each elevated marker, HR 2.64, 95% CI 1.63-4.28, P , 0.001). Integrated discrimination analyses indicated that the use of these three markers in a multimarker approach uniquely improved prediction of death. ConclusionsBiomarkers reflecting remodelling (sST2), myonecrosis (hsTnT), and myocardial stretch (NT-proBNP) provide complementary prognostic information in patients with ADHF. When used together, these novel markers provide superior risk stratification.--

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

“…A new and still not adequately investigated biomarker is soluble ST2, which is involved in cardiac remodelling and overload (54) . An increase in ST2 above 10 ng/mL is considered a predictor of mortality in patients with AHF (p < 0.001) (55) .…”

Estimating systemic fibrosis by combining galectin-3 and ST2 provides powerful risk stratification value for patients after acute decompensated heart failure

“…In a brief communication, Mueller et al [6] reported that increased ST2 concentrations predicted 1-year mortality in 137 patients with acute destabilized HF. Later on, Pascual-Figal et al [7] demonstrated that ST2 provided prognostic value in addition to NT-proBNP and high-sensitivity troponin T in 107 patients with acutely decompensated HF. Recently, Figure 1.…”

“…ST2 is a protein of the interleukin-1 receptor family. Elevated serum levels of soluble ST2 are also associated with adverse outcomes in patients with acute decompensated or chronic HF [6][7][8].…”

Recent Advances in Biomarker Discovery — from Serum to Imaging-based Biomarkers for a Complex Assessment of Heart Failure Patients

“…In this study, hsTnT, NT-proBNP and sST2 offered complementary prognostic information in patients with ADHF, concluding that a panel containing these 3 biomarkers can provide superior risk stratification compared to the isolated use of each one. 27 Another prospective study on 202 patients with ADHF demonstrated that hsTnT assay offered an overall comparable prognostic information to conventional troponin T(cTnT). However, in unclear cases where cTnT was less precise or negative, increased levels of hsTnT were able to provide the requested prognostic information.…”