Prognostic Value of Serial Measurements of Soluble Suppression of Tumorigenicity 2 and Galectin-3 in Ambulatory Patients With Chronic Heart Failure.
BACKGROUND
B-Type natriuretic peptides (BNP) and cardiac troponin T (cTnT) predict cardiovascular events in heart failure (HF) patients, but additional refinement in risk stratification may be possible by targeting pathways leading to fibrosis. We aimed to assess the value of serial measurements of soluble suppression of tumorigenicity 2 (sST2) and galectin-3 to identify risk for adverse pathophysiologic processes.


METHODS
New York Heart Association (NYHA) functional class III-IV HF patients (n = 180; LVEF ≤40%) were prospectively evaluated with biomarkers collected every 3 months over 2 years and analyzed regarding a primary end point of death/cardiac transplantation and a secondary end point of HF-related hospitalization or death/transplantation.


RESULTS
Time-dependent univariate analyses demonstrated that elevations of sST2 (≥49.3 ng/mL male, ≥33.5 ng/mL female) and galectin-3 (≥22.1 ng/mL) were predictive of the primary and secondary end points. In multivariate models adjusted for BNP, cTnT, and clinical variables, sST2 but not galectin-3 remained an independent predictor (hazard ratio 3.22, 95% confidence interval 1.76-5.89; P < .001). With serial measurements, only sST2 demonstrated incremental value in reclassifying patients to higher risk.


CONCLUSIONS
Serial monitoring of sST2 (indicating myocardial fibrosis and remodeling) and cTnT (reflecting myocardial injury) identifies highest-risk HF outpatients and may be valuable to guide patient tailored therapy during follow-up evaluations. Serial galectin-3 monitoring in ambulatory HF patients may not be of benefit.
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: miller.wayne@mayo.edu.
Wayne L
WL
Miller
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Amy K
AK
Saenger
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
Diane E
DE
Grill
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
Joshua P
JP
Slusser
University Hospital Germans Trias i Pujol, Barcelona, Spain.
Antoni
A
Bayes-Genis
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Allan S
AS
Jaffe
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D037502:Galectin 3 / Q000097:blood*; D037161:Galectins; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies
D015415:Biomarkers; D001798:Blood Proteins; D037502:Galectin 3; D037161:Galectins; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; C428445:LGALS3 protein, human
Serial biomarkers; chronic heart failure; galectin-3; sST2