title: Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community-Dwelling Population.
abstract: Soluble ST2 (sST2), a marker of myocyte stretch and fibrosis, has prognostic value in many cardiovascular diseases. We hypothesized that sST2 levels are associated with incident heart failure (HF), including subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fraction, and cardiovascular death.
  
  
  
  Baseline serum sST2 was measured in 3915 older, community-dwelling subjects from the Cardiovascular Health Study without prevalent HF. sST2 levels were associated with older age, male sex, black race, traditional cardiovascular risk factors, other biomarkers of inflammation, cardiac stretch, myocardial injury, and fibrosis, and abnormal echocardiographic parameters. In longitudinal analysis, greater sST2 was associated with a higher risk of incident HF and cardiovascular death; however, in multivariate models adjusting for other cardiac risk factors and the cardiac-specific biomarker, N-terminal pro-type B natriuretic peptide, these associations were attenuated. In these models, an sST2 level above the US Food and Drug Administration-approved cut-off value (>35 ng/mL) was significantly associated with incident HF (hazard ratio [HR], 1.20; 95% CI, 1.02-1.43) and cardiovascular death (HR, 1.21; 95% CI, 1.02-1.44), and greater sST2 was continuously associated with cardiovascular death (per 1-ln increment: HR, 1.24; 95% CI, 1.02-1.50). sST2 was not associated with the HF subtypes of HFpEF and HFrEF in adjusted analysis. Addition of sST2 to existing risk models of HF and cardiovascular death modestly improved discrimination and reclassification into a higher risk.
  
  
  
  The predictive value of sST2 for HF of all subtypes and cardiovascular death is modest in an elderly population despite strong cross-sectional associations with risk factors and underlying cardiac pathology.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Ravi H
authors.initials: RH
authors.lastname: Parikh
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
authors.affiliation: Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.affiliation: Inova Heart and Vascular Institute, Inova, Fairfax, VA cdefilip@medicine.umaryland.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: deFilippi
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D012737:Sex Factors; D013318:Stroke Volume; D019209:Troponin C / Q000097:blood
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D010446:Peptide Fragments; D019209:Troponin C; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: biomarker; epidemiology; heart failure; prediction statistics; survival