Key result
Baseline soluble ST2 concentrations were significantly higher in patients with severe aortic stenosis and a low ejection fraction compared to patients with heart failure (p = 0.009).
Why the study?
ST2 is established for predicting outcome in HF, but concentrations had not been compared between optimally treated patients with stable significant LVSD and patients with severe AS.
Does soluble ST2 concentration differ between patients with severe aortic stenosis and those with severe heart failure, and does it predict mortality?
Cohort (n=144)
No
Does soluble ST2 concentration differ between patients with severe aortic stenosis and those with severe heart failure, and does it predict mortality?
p-value: p=0.009
Soluble ST2 concentrations are similarly elevated in patients with severe heart failure and severe aortic stenosis with normal EF, but are significantly higher in aortic stenosis patients with reduced EF, suggesting it may be a marker of subclinical or clinical LV dysfunction in AS.
sST2 may mark LV dysfunction in severe AS; hypothesis-generating for prognosis and requires prospective validation.
BACKGROUND: ST2 is a circulating biomarker that is well established for predicting outcome in heart failure (HF). This is the first study to look at ST2 concentrations in optimally treated patients with stable but significant left ventricular systolic dysfunction (LVSD) compared to patients with severe aortic stenosis (AS). METHODS: Two cohorts were retrospectively studied: 94 patients undergoing transcatheter aortic valve implantation for severe AS (63 with normal ejection fraction [EF] and 31 with reduced EF), and 50 patients with severe LVSD from non-valvular causes. ST2 pre-procedural samples were taken, and repeated again at 3 and 6 months. Patients were followed-up for 2 years. Data was analyzed using SPSS software. RESULTS: Baseline concentrations of soluble ST2 did not differ significantly between the HF group and AS group with normal EF (EF ≥ 50%). However, in the AS group with a low EF (EF < 50%) ST2 concentrations were significantly higher that the HF group (p = 0.009). New York Heart Association class IV HF, baseline N-terminal pro-B-type natriuretic peptide and gender were all independent predictors of soluble ST2 (sST2) baseline concentrations. CONCLUSIONS: Raised ST2 concentrations in the context of severe AS may be a marker for subclinical or clinical left ventricular dysfunction. More research is required to assess its use for assessment of prognosis and response to treatment.
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Cai et al. (2019) conducted a cohort in Severe aortic stenosis and heart failure (n=144). Severe aortic stenosis with low ejection fraction (LVEF < 50%) vs. Heart failure with severe left ventricular systolic dysfunction was evaluated on Baseline soluble ST2 concentration (p=0.009). Baseline soluble ST2 concentrations were significantly higher in patients with severe aortic stenosis and a low ejection fraction compared to patients with heart failure (p = 0.009).
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