Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic dysfunction.
OBJECTIVE
We studied whether the measurement of the soluble form of ST2 (sST2), an interleukin-1 receptor family member, could identify heart failure (HF) patients at risk of sudden cardiac death (SCD).


BACKGROUND
The prediction of SCD remains an important challenge in patients with mild-to-moderate chronic HF. Concentrations of sST2 have been found increased and related to worse long-term outcomes in patients with acute HF. Whether sST2 has a prognostic role in SCD is unknown.


METHODS
A nested case-control study was performed on 36 cases of SCD and 63 control patients (matched for age, sex, and left ventricular ejection fraction) obtained from the MUSIC (MUerte Súbita en Insuficiencia Cardíaca) registry, a 3-year multicenter registry of ambulatory HF patients (New York Heart Association functional class II to III, left ventricular ejection fraction < or =45%). Demographic, clinical, echocardiographic, electrical, and biochemical data were collected at enrollment.


RESULTS
Concentrations of sST2 were greater among decedents (0.23 ng/ml [interquartile range 0.16 to 0.43 ng/ml] vs. 0.12 ng/ml [interquartile range 0.06 to 0.23 ng/ml], p = 0.001) and were predictive of experiencing SCD (+0.1 ng/ml, odds ratio: 1.39, 95% confidence interval: 1.09 to 1.78, p = 0.006). On the basis of a combined biomarker status, only 4% of patients experienced SCD for neither sST2 nor N-terminal pro-B-type natriuretic peptide (NT-proBNP) above receiver-operator characteristic-derived cut-off points (0.15 ng/ml and 2,000 ng/l, respectively), 34% for either biomarker above, and 71% for both biomarkers above (p < 0.001 for trend). This combined variable added incremental prognostic value to the multivariable regression model (p < 0.001).


CONCLUSIONS
Elevated sST2 concentrations are predictive of SCD in patients with chronic HF and provide complementary information to NT-proBNP levels. A combined biomarker approach may have an impact on clinical decision-making.
Pascual-Figal
Domingo A
DA
Cardiology Service, Virgen de la Arrixaca Hospital and Department of Medicine, University of Murcia, Murcia 30120, Spain. dapascual@servicam.com
Ordoñez-Llanos
Jordi
J
Tornel
Pedro L
PL
Vázquez
Rafael
R
Puig
Teresa
T
Valdés
Mariano
M
Cinca
Juan
J
de Luna
Antoni Bayes
AB
Bayes-Genis
Antoni
A
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000150:complications; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D011956:Receptors, Cell Surface / Q000097:blood*; D017472:Receptors, Interleukin-1; D012189:Retrospective Studies; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications / Q000503:physiopathology
D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface; D017472:Receptors, Interleukin-1