High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure

Bonnie Ky, Benjamin French, Kristin McCloskey, J. Eduardo Rame, Erin McIntosh, Puja Shahi, Daniel L. Dries, W. H Wilson Tang, Alan H B Wu, James C. Fang, Rebecca Boxer, Nancy K Sweitzer, Wayne C. Levy, Lee R. Goldberg, Mariell Jessup, Thomas P. Cappola

Research output: Contribution to journalArticle

219 Citations (Scopus)

Abstract

Background-Soluble ST2 reflects activity of an interleukin-33- dependent cardioprotective signaling axis and is a diagnostic and prognostic marker in acute heart failure. The use of ST2 in chronic heart failure has not been well defined. Our objective was to determine whether plasma ST2 levels predict adverse outcomes in chronic heart failure in the context of current approaches. Methods and Results-We determined the association between ST2 level and risk of death or transplantation in a multicenter, prospective cohort of 1141 chronic heart failure outpatients. Adjusted Cox models, receiver operating characteristic analyses, and risk reclassification metrics were used to assess the value of ST2 in predicting risk beyond currently used factors. After a median of 2.8 years, 267 patients (23%) died or underwent heart transplantation. Patients in the highest ST2 tertile (ST2 ≤36.3 ng/mL) had a markedly increased risk of adverse outcomes compared with the lowest tertile (ST2 ≤22.3 ng/mL), with an unadjusted hazard ratio of 3.2 (95% confidence interval [CI], 2.2 to 4.7; P<0.0001) that remained significant after multivariable adjustment (adjusted hazard ratio, 1.9; 95% CI, 1.3 to 2.9; P=0.002). In receiver operating characteristic analyses, the area under the curve for ST2 was 0.75 (95% CI, 0.69 to 0.79), which was similar to N-terminal pro-B-type natriuretic peptide (NT-proBNP) (area under the curve, 0.77; 95% CI, 0.72 to 0.81; P=0.24 versus ST2) but lower than the Seattle Heart Failure Model (area under the curve, 0.81 (95% CI, 0.77 to 0.85; P=0.014 versus ST2). Addition of ST2 and NT-proBNP to the Seattle Heart Failure Model reclassified 14.9% of patients into more appropriate risk categories (P=0.017). Conclusions-ST2 is a potent marker of risk in chronic heart failure and when used in combination with NT-proBNP offers moderate improvement in assessing prognosis beyond clinical risk scores.

Original languageEnglish (US)
Pages (from-to)180-187
Number of pages8
JournalCirculation: Heart Failure
Volume4
Issue number2
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Heart Failure
Confidence Intervals
Brain Natriuretic Peptide
Area Under Curve
ROC Curve
Heart Transplantation
Proportional Hazards Models
Outpatients
Transplantation

Keywords

  • Cardiomyopathy
  • Chronic heart failure
  • ST2

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Ky, B., French, B., McCloskey, K., Rame, J. E., McIntosh, E., Shahi, P., ... Cappola, T. P. (2011). High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure. Circulation: Heart Failure, 4(2), 180-187. https://doi.org/10.1161/CIRCHEARTFAILURE.110.958223

High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure. / Ky, Bonnie; French, Benjamin; McCloskey, Kristin; Rame, J. Eduardo; McIntosh, Erin; Shahi, Puja; Dries, Daniel L.; Tang, W. H Wilson; Wu, Alan H B; Fang, James C.; Boxer, Rebecca; Sweitzer, Nancy K; Levy, Wayne C.; Goldberg, Lee R.; Jessup, Mariell; Cappola, Thomas P.

In: Circulation: Heart Failure, Vol. 4, No. 2, 03.2011, p. 180-187.

Research output: Contribution to journalArticle

Ky, B, French, B, McCloskey, K, Rame, JE, McIntosh, E, Shahi, P, Dries, DL, Tang, WHW, Wu, AHB, Fang, JC, Boxer, R, Sweitzer, NK, Levy, WC, Goldberg, LR, Jessup, M & Cappola, TP 2011, 'High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure', Circulation: Heart Failure, vol. 4, no. 2, pp. 180-187. https://doi.org/10.1161/CIRCHEARTFAILURE.110.958223
Ky, Bonnie ; French, Benjamin ; McCloskey, Kristin ; Rame, J. Eduardo ; McIntosh, Erin ; Shahi, Puja ; Dries, Daniel L. ; Tang, W. H Wilson ; Wu, Alan H B ; Fang, James C. ; Boxer, Rebecca ; Sweitzer, Nancy K ; Levy, Wayne C. ; Goldberg, Lee R. ; Jessup, Mariell ; Cappola, Thomas P. / High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure. In: Circulation: Heart Failure. 2011 ; Vol. 4, No. 2. pp. 180-187.
@article{71af7c825c7e412293cea15d9db71d93,
title = "High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure",
abstract = "Background-Soluble ST2 reflects activity of an interleukin-33- dependent cardioprotective signaling axis and is a diagnostic and prognostic marker in acute heart failure. The use of ST2 in chronic heart failure has not been well defined. Our objective was to determine whether plasma ST2 levels predict adverse outcomes in chronic heart failure in the context of current approaches. Methods and Results-We determined the association between ST2 level and risk of death or transplantation in a multicenter, prospective cohort of 1141 chronic heart failure outpatients. Adjusted Cox models, receiver operating characteristic analyses, and risk reclassification metrics were used to assess the value of ST2 in predicting risk beyond currently used factors. After a median of 2.8 years, 267 patients (23{\%}) died or underwent heart transplantation. Patients in the highest ST2 tertile (ST2 ≤36.3 ng/mL) had a markedly increased risk of adverse outcomes compared with the lowest tertile (ST2 ≤22.3 ng/mL), with an unadjusted hazard ratio of 3.2 (95{\%} confidence interval [CI], 2.2 to 4.7; P<0.0001) that remained significant after multivariable adjustment (adjusted hazard ratio, 1.9; 95{\%} CI, 1.3 to 2.9; P=0.002). In receiver operating characteristic analyses, the area under the curve for ST2 was 0.75 (95{\%} CI, 0.69 to 0.79), which was similar to N-terminal pro-B-type natriuretic peptide (NT-proBNP) (area under the curve, 0.77; 95{\%} CI, 0.72 to 0.81; P=0.24 versus ST2) but lower than the Seattle Heart Failure Model (area under the curve, 0.81 (95{\%} CI, 0.77 to 0.85; P=0.014 versus ST2). Addition of ST2 and NT-proBNP to the Seattle Heart Failure Model reclassified 14.9{\%} of patients into more appropriate risk categories (P=0.017). Conclusions-ST2 is a potent marker of risk in chronic heart failure and when used in combination with NT-proBNP offers moderate improvement in assessing prognosis beyond clinical risk scores.",
keywords = "Cardiomyopathy, Chronic heart failure, ST2",
author = "Bonnie Ky and Benjamin French and Kristin McCloskey and Rame, {J. Eduardo} and Erin McIntosh and Puja Shahi and Dries, {Daniel L.} and Tang, {W. H Wilson} and Wu, {Alan H B} and Fang, {James C.} and Rebecca Boxer and Sweitzer, {Nancy K} and Levy, {Wayne C.} and Goldberg, {Lee R.} and Mariell Jessup and Cappola, {Thomas P.}",
year = "2011",
month = "3",
doi = "10.1161/CIRCHEARTFAILURE.110.958223",
language = "English (US)",
volume = "4",
pages = "180--187",
journal = "Circulation: Heart Failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure

AU - Ky, Bonnie

AU - French, Benjamin

AU - McCloskey, Kristin

AU - Rame, J. Eduardo

AU - McIntosh, Erin

AU - Shahi, Puja

AU - Dries, Daniel L.

AU - Tang, W. H Wilson

AU - Wu, Alan H B

AU - Fang, James C.

AU - Boxer, Rebecca

AU - Sweitzer, Nancy K

AU - Levy, Wayne C.

AU - Goldberg, Lee R.

AU - Jessup, Mariell

AU - Cappola, Thomas P.

PY - 2011/3

Y1 - 2011/3

N2 - Background-Soluble ST2 reflects activity of an interleukin-33- dependent cardioprotective signaling axis and is a diagnostic and prognostic marker in acute heart failure. The use of ST2 in chronic heart failure has not been well defined. Our objective was to determine whether plasma ST2 levels predict adverse outcomes in chronic heart failure in the context of current approaches. Methods and Results-We determined the association between ST2 level and risk of death or transplantation in a multicenter, prospective cohort of 1141 chronic heart failure outpatients. Adjusted Cox models, receiver operating characteristic analyses, and risk reclassification metrics were used to assess the value of ST2 in predicting risk beyond currently used factors. After a median of 2.8 years, 267 patients (23%) died or underwent heart transplantation. Patients in the highest ST2 tertile (ST2 ≤36.3 ng/mL) had a markedly increased risk of adverse outcomes compared with the lowest tertile (ST2 ≤22.3 ng/mL), with an unadjusted hazard ratio of 3.2 (95% confidence interval [CI], 2.2 to 4.7; P<0.0001) that remained significant after multivariable adjustment (adjusted hazard ratio, 1.9; 95% CI, 1.3 to 2.9; P=0.002). In receiver operating characteristic analyses, the area under the curve for ST2 was 0.75 (95% CI, 0.69 to 0.79), which was similar to N-terminal pro-B-type natriuretic peptide (NT-proBNP) (area under the curve, 0.77; 95% CI, 0.72 to 0.81; P=0.24 versus ST2) but lower than the Seattle Heart Failure Model (area under the curve, 0.81 (95% CI, 0.77 to 0.85; P=0.014 versus ST2). Addition of ST2 and NT-proBNP to the Seattle Heart Failure Model reclassified 14.9% of patients into more appropriate risk categories (P=0.017). Conclusions-ST2 is a potent marker of risk in chronic heart failure and when used in combination with NT-proBNP offers moderate improvement in assessing prognosis beyond clinical risk scores.

AB - Background-Soluble ST2 reflects activity of an interleukin-33- dependent cardioprotective signaling axis and is a diagnostic and prognostic marker in acute heart failure. The use of ST2 in chronic heart failure has not been well defined. Our objective was to determine whether plasma ST2 levels predict adverse outcomes in chronic heart failure in the context of current approaches. Methods and Results-We determined the association between ST2 level and risk of death or transplantation in a multicenter, prospective cohort of 1141 chronic heart failure outpatients. Adjusted Cox models, receiver operating characteristic analyses, and risk reclassification metrics were used to assess the value of ST2 in predicting risk beyond currently used factors. After a median of 2.8 years, 267 patients (23%) died or underwent heart transplantation. Patients in the highest ST2 tertile (ST2 ≤36.3 ng/mL) had a markedly increased risk of adverse outcomes compared with the lowest tertile (ST2 ≤22.3 ng/mL), with an unadjusted hazard ratio of 3.2 (95% confidence interval [CI], 2.2 to 4.7; P<0.0001) that remained significant after multivariable adjustment (adjusted hazard ratio, 1.9; 95% CI, 1.3 to 2.9; P=0.002). In receiver operating characteristic analyses, the area under the curve for ST2 was 0.75 (95% CI, 0.69 to 0.79), which was similar to N-terminal pro-B-type natriuretic peptide (NT-proBNP) (area under the curve, 0.77; 95% CI, 0.72 to 0.81; P=0.24 versus ST2) but lower than the Seattle Heart Failure Model (area under the curve, 0.81 (95% CI, 0.77 to 0.85; P=0.014 versus ST2). Addition of ST2 and NT-proBNP to the Seattle Heart Failure Model reclassified 14.9% of patients into more appropriate risk categories (P=0.017). Conclusions-ST2 is a potent marker of risk in chronic heart failure and when used in combination with NT-proBNP offers moderate improvement in assessing prognosis beyond clinical risk scores.

KW - Cardiomyopathy

KW - Chronic heart failure

KW - ST2

UR - http://www.scopus.com/inward/record.url?scp=79955943158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955943158&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.110.958223

DO - 10.1161/CIRCHEARTFAILURE.110.958223

M3 - Article

C2 - 21178018

AN - SCOPUS:79955943158

VL - 4

SP - 180

EP - 187

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3297

IS - 2

ER -