title: Serial soluble ST2 for the monitoring of pharmacologically optimised chronic stable heart failure.
abstract: BACKGROUND
  Soluble ST2 (sST2) is an emerging biomarker of cardiac remodelling and fibrosis. Studies indicate that it is predictive of mortality in acutely decompensated heart failure. The role of sST2 in chronic heart failure (CHF) is less well defined. No studies have examined serial measurements in optimised patients as a potential monitoring tool. This study aimed to prospectively determine the prognostic utility of serial sST2 in patients with pharmacologically optimised stable CHF.
  
  
  METHODS
  41 patients with pharmacologically optimised CHF and left ventricular ejection fraction ≤40% were recruited. Clinical review and blood sampling took place at baseline, and one, three and six months. N-terminal pro-brain natriuretic peptide (NTproBNP), sST2 and renal profile were measured on all samples. 12 lead electrocardiogram (ECG) was performed at baseline. Decompensation was defined as a composite endpoint of cardiovascular admission or worsening renal function (≥25% increase in serum creatinine from baseline).
  
  
  RESULTS
  Receiver operator curve analysis of percentage change in sST2 from baseline to six months was strongly reflective of decompensation with area under the curve (AUC) of 0.778. This was significantly better than NTproBNP (AUC 0.425; p=0.013). Correlation of baseline concentrations to surface ECG showed that both sST2 and NTproBNP were positively correlated with duration of the QRS wave, with higher level of significance demonstrated by sST2 (0.415 (p=0.007) and 0.362 (p=0.020) respectively).
  
  
  CONCLUSIONS
  Percentage changes in sST2 are better able to predict cardiovascular admission or worsening renal function in patients with pharmacologically optimised CHF than NTproBNP. Compared with NTproBNP, sST2 appears to be a promising candidate for monitoring these patients.
authors.affiliation: Department of Cardiovascular Research, King's College London, The James Black Centre, 125 Coldharbour Lane, London SE5 9NU, United Kingdom; Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. Electronic address: susan.piper@kcl.ac.uk.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Piper
authors.affiliation: Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. Electronic address: roy.sherwood@nhs.net.
authors.forename: Roy A
authors.initials: RA
authors.lastname: Sherwood
authors.affiliation: Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. Electronic address: george.amin-youssef@nhs.net.
authors.forename: George F
authors.initials: GF
authors.lastname: Amin-Youssef
authors.affiliation: Department of Cardiovascular Research, King's College London, The James Black Centre, 125 Coldharbour Lane, London SE5 9NU, United Kingdom. Electronic address: ajay.shah@kcl.ac.uk.
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: Department of Cardiovascular Research, King's College London, The James Black Centre, 125 Coldharbour Lane, London SE5 9NU, United Kingdom; Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. Electronic address: theresa.mcdonagh@kcl.ac.uk.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: McDonagh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D011956:Receptors, Cell Surface / Q000097:blood*
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface
keywords: Biomarkers; Chronic heart failure; Monitoring