title: Soluble concentrations of the interleukin receptor family member ST2 and β-blocker therapy in chronic heart failure.
abstract: BACKGROUND
  Concentrations of soluble (s)ST2 predict prognosis in heart failure. We recently found changing doses of β-blocker (BB) may affect sST2 concentrations. It remains unclear whether sST2 concentrations identify benefit of BB therapy, however.
  
  
  RESULTS
  A total of 151 subjects with heart failure attributable to left ventricular systolic dysfunction were examined in this post hoc analysis; >96% were taking BB at enrollment. Medication regimen and sST2 values were obtained during 10 months. Cardiovascular events were examined as a function of baseline sST2 status (low ≤35 versus high >35 ng/mL) and final achieved BB dose (high ≥50 versus low <50 mg daily equivalent dose of metoprolol succinate). Patients with low sST2 titrated to high-dose BB had the lowest cardiovascular event rate at 0.53 events (P=0.001), and lowest cumulative hazard (P=0.003). Those with low sST2/low-dose BB, or high sST2/high-dose BB had intermediate outcomes (0.92 and 1.19 events). Patients with high sST2 treated with low-dose BB had the highest cardiovascular event rate (2.08 events) and the highest cumulative hazard. Compared with low sST2/high-dose BB, those with high sST2 treated with low-dose BB had an odds ratio of 6.77 (P<0.001) for a cardiovascular event. Patients with low sST2/low-dose BB or high sST2/high-dose BB had intermediate odds ratios for cardiovascular events (P=0.18 and 0.02). Similar results were found for heart failure hospitalization and cardiovascular death.
  
  
  CONCLUSIONS
  Although BB therapy exerted dose-related benefits across all study participants, sST2 measurement identifies patients with chronic heart failure who may particularly benefit from higher BB doses.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00351390.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.forename: Shweta
authors.initials: S
authors.lastname: Motiwala
authors.forename: Anju
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Parks
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011956:Receptors, Cell Surface / Q000097:blood*; D017472:Receptors, Interleukin-1 / Q000097:blood; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface; D017472:Receptors, Interleukin-1
keywords: biological markers; heart failure; prognosis; β-adrenergic blockers