title: Soluble ST2 and Risk of Arrhythmias, Heart Failure, or Death in Patients with Mildly Symptomatic Heart Failure: Results from MADIT-CRT.
abstract: Soluble ST2 is an established biomarker of heart failure (HF) progression. Data about its prognostic implications in patients with mildly symptomatic HF eligible to receive cardiac resynchronization therapy defibrillators (CRT-D) are limited. In a cohort of 684 patients enrolled in Multicenter Automated Defibrillator Implantation Trial (MADIT)-CRT, levels of soluble ST2 (sST2) were serially assessed at baseline and 1 year (n = 410). In multivariable-adjusted models, elevated baseline sST2 was associated with an increased risk of death, death or HF, and death or ventricular arrhythmia (VA) even when adjusting for baseline brain natriuretic protein (BNP) levels. In addition, patients with lower baseline sST2 levels had greater risk reduction with CRT-D (p = 0.006). Serial assessment revealed increased risk of VA and death or VA (HR per 10 % increase in sST2 1.11 (1.04-1.20), p = 0.004). Among patients with mildly symptomatic HF and eligibility for CRT-D, baseline and serial assessments sST2 may provide important information for risk stratification.
authors: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. hskali@post.harvard.edu.
authors: Hicham
authors: H
authors: Skali
authors: Critical Diagnostics, San Diego, CA, USA.
authors: Robert
authors: R
authors: Gerwien
authors: Boston Scientific, St. Paul, MN, USA.
authors: Timothy E
authors: TE
authors: Meyer
authors: Critical Diagnostics, San Diego, CA, USA.
authors: James V
authors: JV
authors: Snider
authors: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors: Scott D
authors: SD
authors: Solomon
authors: Boston Scientific, St. Paul, MN, USA. craig.stolen@bsci.com.
authors: Craig M
authors: CM
authors: Stolen
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000209:etiology* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects* / Q000401:mortality; D017147:Defibrillators, Implantable; D018450:Disease Progression; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D020097:Natriuretic Peptide, Brain
keywords: Arrhythmia; Biomarker; Cardiac resynchronization therapy (CRT); Heart failure; Implantable cardioverter defibrillator (ICD); Prognosis; ST2; Sudden cardiac death