Key result
Elevated soluble ST2 linked to ~3.3-fold higher mortality in severe heart failure with ICDs.
Why the study?
Although ICD therapies reduce mortality in high-risk heart failure patients, it is necessary to identify factors that predict mortality after device implantation.
Does elevated baseline soluble ST2 predict all-cause mortality in severe heart failure patients implanted with an ICD?
Cohort (n=150)
No
Does elevated baseline soluble ST2 predict all-cause mortality in severe heart failure patients implanted with an ICD?
Hazard Ratio: 3.3 (95% CI 1.02–10.67)
Absolute Event Rate: 21.2% vs 5.1%
p-value: p=0.002
Baseline soluble ST2 is a strong, independent predictor of all-cause mortality in patients with advanced heart failure who undergo ICD implantation, which may aid in risk stratification.
May aid risk stratification in severe HF-ICD patients; leaves open whether it guides therapy or improves outcomes.
Background. Heart failure (HF) is the terminal stage of all cardiovascular events. Although implantable cardioverter defibrillator (ICD) therapies have reduced mortality among the high-risk HF population, it is necessary to determine whether certain factors can predict mortality even after cardiac device implantation. Growth stimulation expressed gene 2 (ST2) is an emerging biomarker for HF patient stratification in different clinical settings. Aims. This study aimed to investigate the relationship between baseline soluble ST2 (sST2) levels in serum and the clinical outcomes of high-risk HF patients with device implantation. Methods. Between January 2017 and August 2018, we prospectively recruited consecutive patients implanted with an ICD for heart failure, with LVEF ≤35% as recommended, and analyzed the basic characteristics, baseline serum sST2, and NT-proBNP levels, with at least 1-year follow-up. All-cause mortality was the primary endpoint. Results. During a 643-day follow-up, all-cause mortality occurred in 16 of 150 patients (10.67%). Incidence of all-cause mortality increased significantly in patients with sST2 levels above 34.98846 ng/ml (16.00% vs. 5.33%, P = 0.034 ). After adjusting the model (age, gender, device implantation, prevention of sudden death, LVEDD, LVEF, WBC and CLBBB, hsTNT, etiology, and eGFR) and the model combined with NT-proBNP, the risk of all-cause death was increased by 2.5% and 1.9%, respectively, per ng/ml of sST2. The best sST2 cutoff for predicting all-cause death was 43.42671 ng/ml (area under the curve: 0.72, sensitive: 0.69, and specificity: 0.69). Compared to patients with sST2 levels below 43.42671 ng/ml, the risk of all-cause mortality was higher in those with values above the threshold (5.1% vs. 21.2%, P = 0.002 ). ST2 level ≥43.42671 ng/ml was an independent predictor of all-cause mortality (HR: 3.30 [95% CI 1.02–10.67]). Age (HR: 1.06 [95% CI: 1.01–1.12]) and increased NT-proBNP per 100 (HR: 1.02 [95% CI: 1.01–1.03]) were also associated with all-cause mortality in ICD patients. Conclusions. sST2 level was associated with risk of all-cause mortality, and a threshold of 43.43 ng/ml showed good distinguishing performance to predict all-cause mortality in patients with severe heart failure, recommended for ICD implantation. Patients with sST2 levels more than 43.42671 ng/ml even after ICD implantation should therefore be monitored carefully.
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Yu et al. (2020) conducted a cohort in Heart failure with reduced ejection fraction (LVEF ≤35%) with ICD (n=150). Soluble ST2 level ≥ 43.43 ng/ml vs. Soluble ST2 level < 43.43 ng/ml was evaluated on All-cause mortality (HR 3.30, 95% CI 1.02-10.67, p=0.002). Baseline soluble ST2 levels ≥43.43 ng/ml independently predicted a higher risk of all-cause mortality (HR 3.30) in patients with severe heart failure implanted with an ICD.
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