Key result
Higher baseline sST2/LVMI ratio is linked to ~64% higher CV death or HF rehospitalization in HFrEF.
Why the study?
Inflammation triggers left ventricular fibrosis and remodeling in heart failure, and the prognostic value of the sST2/LVMI ratio in HFrEF patients was unclear.
Does the baseline sST2/LVMI ratio predict cardiovascular mortality and heart failure rehospitalization in patients with heart failure with reduced ejection fraction?
Cohort (n=45)
No
Does the baseline sST2/LVMI ratio predict cardiovascular mortality and heart failure rehospitalization in patients with heart failure with reduced ejection fraction?
Hazard Ratio: 1.64 (95% CI 1.06–2.54)
A higher baseline sST2/LVMI ratio is associated with an increased risk of cardiovascular mortality and heart failure rehospitalization in patients with HFrEF.
Higher sST2/LVMI ratio was associated with increased short-term CV mortality and HF rehospitalization in HFrEF; leaves open incremental value beyond established markers in larger studies.
BACKGROUND: Inflammation is one of the principal triggering mechanisms for left ventricular fibrosis and remodeling in heart failure, leading to adverse clinical outcomes. Soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, is assumed to play a significant role in the fibrotic response to inflammation. Left ventricular mass index (LVMI) is a parameter of the prefibrotic inflammatory phase of heart failure preceding remodeling. The present study aimed to investigate the prognostic value of the sST2/LVMI ratio in heart failure with reduced ejection fraction. METHODS: This was a prospective cohort study. A total of 45 consecutive patients with heart failure with reduced ejection fraction, treated between September 2015 and December 2016, were enrolled. The sST2/LVMI ratio was measured at baseline. The primary endpoint was a composite of cardiovascular mortality and readmission for heart failure. The prognostic impact of the sST2/LVMI ratio was evaluated using a multivariable Cox proportional hazards regression model. RESULTS: Forty-five patients were enrolled in this study. Their average age was 48 ± 14 years, and approximately 20% of them were men. Patients were followed for 9 months, during which the primary outcome occurred in 15 patients. Kaplan-Meier analysis showed that patients with a high sST2/LVMI ratio (≥ 0.39) had shorter event-free survival than those with intermediate (between 0.39 and 0.24) and low ratios (< 0.24) (log-rank, P = 0.022). The fully adjusted multivariable Cox regression analysis showed that the sST2/LVMI ratio was positively associated with the composite outcome in patients with heart failure with reduced ejection fraction after adjusting for confounders (hazard ratio 1.64, 95% confidence interval 1.06 to 2.54). By subgroup analysis, a stronger association was found with age between 40 and 55 years, systolic blood pressure < 115 or ≥ 129 mmHg, diastolic blood pressure < 74 mmHg, hematocrit < 44.5%, and interventricular septum thickness ≥ 8.5 mm. CONCLUSION: In patients with heart failure with reduced ejection fraction, the relationship between the sST2/LVMI ratio and the composite outcome was linear. A higher baseline ratio of sST2/LVMI was associated with an increased risk of cardiovascular mortality and heart failure rehospitalization in the short-term follow-up.
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Li et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (n=45). sST2/LVMI ratio vs. Lower sST2/LVMI ratio was evaluated on Composite of cardiovascular mortality and readmission for heart failure (HR 1.64, 95% CI 1.06-2.54). A higher baseline sST2/LVMI ratio was associated with an increased risk of cardiovascular mortality and heart failure rehospitalization in patients with heart failure with reduced ejection fraction (HR 1.64).
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