sST2 predicts death, hospitalization in chronic HF beyond NT-proBNP, hsTnT
Soluble suppression of tumorigenesis-2 (sST2) is a strong, independent predictor of all-cause and cardiovascular mortality, as well as heart failure (HF) hospitalization in chronic HF, reports a study.
The authors retrieved individual patient data from studies that assessed sST2 for risk prediction in chronic HF, together with N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT).
Of the 4,268 patients evaluated (median age 68 years; 75 percent males), 65 percent had ischaemic HF and 87 percent had left ventricular ejection fraction (LVEF) <40 percent. NT-proBNP was 1,360 ng/l (interquartile interval, 513–3,222 ng/l), hs-TnT 18 ng/l (interquartile interval, 9–33 ng/l) and sST2 27 ng/l (interquartile interval, 20–39 ng/l).
All-cause death occurred in 1,319 patients (31 percent), while cardiovascular death occurred in 939 (22 percent), during a median follow-up of 2.4 years. Of the patients, 4,118 (96 percent) had available data, of which 1,029 (24 percent) were hospitalized at least once for worsening HF over 2.2 years.
The best sST2 cutoff for predicting all-cause and cardiovascular death and HF hospitalization was 28 ng/ml, with good performance at Kaplan-Meier analysis (log-ran: 117.6, 61.0 and 88.6, respectively; p<0.001 for all).
A model including age, sex, body mass index, ischaemic aetiology, LVEF, New York Heart Association functional class, glomerular filtration rate, HF medical therapy, NT-proBNP and hs-TnT showed that the risk of all-cause mortality increased by 26 percent, cardiovascular mortality by 25 percent and HF hospitalization by 30 percent per each doubling of sST2.
Additionally, the independent prognostic value of sST2 persisted across most population subgroups.
According to the authors, sSt2 deserves consideration to be part of a multimarker panel together with NT-proBNP and hs-TnT.