Heart failure therapy-induced early ST2 changes may offer long-term therapy guidance.
BACKGROUND
Biomarkers may help to monitor and tailor treatment in patients with acute heart failure (AHF).


RESULTS
Levels of ST2, a novel biomarker integrating hypervolemic cardiac strain and proinflammatory signals, were measured at presentation to the emergency department (ED) and after 48 hours in 207 patients with AHF. Patients were stratified according to their early ST2 response (responders: ST2 decrease ≥25%; nonresponders: ST2 decrease <25%) and beta-blocker, renin-angiotensin-aldosterone system (RAAS) blockade, or diuretic treatment status at hospital discharge. We assessed the utility of ST2 levels and its changes to predict long-term mortality and the interaction between ST2 levels, treatment at discharge, and 1-year mortality. ST2 levels were higher in nonsurvivors than in survivors (median 108 vs 69 ng/mL; P < .01) and decreased significantly during the 1st 48 hours (median decrease 33%). ST2 decrease was less in nonsurvivors compared with survivors (median -25% vs -42%; P < .01). In Cox regression, early ST2 changes independently predicted 1-year mortality (hazard ratio 1.07 for every increase of 10%; P = .02). RAAS blockers at discharge were associated with survival independently from ST2 response, whereas the association of beta-blockers with survival differed markedly according to ST2 response, with beneficial effects restricted to ST2 nonresponders (P interaction = .04). A similar, albeit nonsignificant, trend was observed for diuretics (P interaction = .11).


CONCLUSIONS
ED and serial ST2 measurements are independent predictors of 1-year mortality in AHF.
Department of Nephrology, University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland. Electronic address: breidthardtt@uhbs.ch.
Tobias
T
Breidthardt
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Cathrin
C
Balmelli
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Raphael
R
Twerenbold
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Tamina
T
Mosimann
Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
Jaqueline
J
Espinola
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Philip
P
Haaf
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Gregor
G
Thalmann
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Berit
B
Moehring
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Mira
M
Mueller
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Bernadette
B
Meller
Department of Cardiology, University Hospital Basel, Basel, Switzerland; Clinical Trial Unit, University Hospital Basel, Basel, Switzerland.
Tobias
T
Reichlin
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Karsten
K
Murray
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Ronny
R
Ziller
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Pascal
P
Benkert
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Stefan
S
Osswald
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Christian
C
Mueller
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D011956:Receptors, Cell Surface / Q000097:blood*; D013997:Time Factors
D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface
Acute heart failure; ST2; heart failure therapy; mortality