title: Prediction of survival and magnitude of reverse remodeling using the ST2-R2 score in heart failure: A multicenter study.
abstract: BACKGROUND
  Cardiac remodeling and its reversibility are key in HF outcomes. The ST2-R2 score was recently developed to predict relevant left ventricular (LV) reverse remodeling (R2) in patients with heart failure (HF). In the present study we sought to validate the ST2-R2 score for grading improvement in LV ejection fraction (EF) and LV size at one year, and to evaluate its prognostic implication up to 4 years.
  
  
  METHODS
  A total of 569 patients with baseline LVEF <40% from three international cohorts (Barcelona, TIME-CHF, and PROTECT) were included in the study. Patients were classified into four strata based on their ST2-R2 score, which took into account concentrations of the biomarker ST2, non-ischemic etiology, absence of left bundle branch block, HF duration, baseline LVEF, and β-blocker treatment.
  
  
  RESULTS
  A significant relationship was observed between ST2-R2 scores and changes in LVEF and indexed LV sizes. LVEF recovery (from +5.6% to +17.3%; p<0.001), percentage reduction in LV end-systolic volume index (from -6.1% to -32.1%; p<0.001) and in LV end-systolic diameter index (from -1.1% to -18.6%; p<0.001) increased over the ST2-R2 strata. A similar trend was observed with diastolic parameters. Improvement in LV function and size was inversely predictive of mortality. Hazard ratios for risk of death, using the lower ST2-R2 score strata (<9) as a reference, were 0.49 (p<0.001; score 9-11), 0.27 (p<0.001; score 12-14), and 0.17 (p<0.001; score 15-17).
  
  
  CONCLUSIONS
  The ST2-R2 score predicts reverse LV remodeling in HF patients and is useful for predicting mortality up to 4years.
authors.affiliation: Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.affiliation: Department of Cardiology, Maastricht University Medical Center MUMC, Maastricht, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sanders-van Wijk
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Hanna K
authors.initials: HK
authors.lastname: Gaggin
authors.affiliation: University Hospital Basel, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
authors.affiliation: Servei de Bioquímica, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Galán
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Cardiology, Maastricht University Medical Center MUMC, Maastricht, The Netherlands.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.affiliation: Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: abayesgenis@gmail.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Biomarkers; Heart failure; LVEF; Reverse remodeling; ST2; Survival