Key result
Elevated plasma soluble ST2 levels (>23 ng/mL) independently predicted the development of heart failure symptoms and cardiovascular events in asymptomatic patients with aortic stenosis (HR 2.42).
Why the study?
Does elevated plasma soluble ST2 predict heart failure symptoms and cardiovascular events in patients with aortic stenosis?
Cohort (n=86)
No
Does elevated plasma soluble ST2 predict heart failure symptoms and cardiovascular events in patients with aortic stenosis?
Hazard Ratio: 2.42 (95% CI 1.07–5.44)
p-value: p=0.033
Elevated plasma soluble ST2 provides complementary prognostic information to BNP in patients with aortic stenosis, independently predicting symptomatic status and new-onset heart failure events.
May support risk stratification in asymptomatic aortic stenosis; leaves open whether sST2 adds value beyond BNP for guiding intervention.
B-type natriuretic peptide (BNP) is often used as a complementary finding in the diagnostic work-up of patients with aortic stenosis (AS). Whether soluble ST2, a new biomarker of cardiac stretch, is associated with symptomatic status and outcome in asymptomatic AS is unknown. sST2 and BNP levels were measured in 86 patients (74±13 years; 59 asymptomatic, 69%) with AS (<1.5 cm2) and preserved left ventricular ejection fraction who were followed-up for 26±16 months. Both BNP and sST2 were associated with NYHA class but sST2 (>23 ng/mL, AUC = 0.68, p<0.01) was more accurate to identify asymptomatic patients or those who developed symptoms during follow-up. sST2 was independently related to left atrial index (p<0.0001) and aortic valve area (p = 0.004; model R2 = 0.32). A modest correlation was found with BNP (r = 0.4, p<0.01). During follow-up, 29 asymptomatic patients (34%) developed heart failure symptoms. With multivariable analysis, peak aortic jet velocity (HR = 2.7, p = 0.007) and sST2 level (HR = 1.04, p = 0.03) were independent predictors of cardiovascular events. In AS, sST2 levels could provide complementary information regarding symptomatic status, new onset heart failure symptoms and outcome. It might become a promising biomarker in these patients.
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Lancellotti et al. (2015) conducted a cohort in Aortic Stenosis (n=86). Elevated plasma soluble ST2 (>23 ng/mL) vs. sST2 ≤ 23 ng/mL was evaluated on New onset heart failure symptoms related events (death, dyspnea, acute pulmonary edema) (HR 2.42, 95% CI 1.07-5.44, p=0.033). Elevated plasma soluble ST2 levels (>23 ng/mL) independently predicted the development of heart failure symptoms and cardiovascular events in asymptomatic patients with aortic stenosis (HR 2.42).
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