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Chen Y, Guan J, Qi C, Wu Y, Wang J, Zhao X, Li X, He C, Zhang J, Zhang Y. Association of point-of-care testing for sST2 with clinical outcomes in patients hospitalized with heart failure. ESC Heart Fail 2024. [PMID: 38773746 DOI: 10.1002/ehf2.14860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/24/2024] Open
Abstract
AIMS This study aimed to investigate the association of soluble suppression of tumorigenicity-2 (sST2) measured by point-of-care testing assay with clinical outcomes in patients hospitalized with heart failure after adjusting for other predictors including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT). METHODS A total of 1726 consecutive patients hospitalized with heart failure from July 2015 to December 2021 were enrolled. Baseline serum sST2 concentrations were measured by immunofluorescence assay. Primary endpoint event was the composite of all-cause death, heart transplantation, or left ventricular assist device. RESULTS During the median follow-up duration of 682 days, 434 patients (25.1%) suffered from primary endpoint events. Baseline sST2 remained an independent predictor of the primary endpoint event in patients hospitalized with heart failure after adjusting for other predictors including NT-proBNP and hs-cTnT [per log (unit) increase, adjusted hazard ratio (HR) (95% confidence interval) (CI): 1.20 (1.09, 1.32), P < 0.001]. And baseline sST2 had a better prognostic value for patients with chronic decompensated heart failure [per log (unit) increase, adjusted HR (95% CI): 1.19 (1.07, 1.31)] than for those with acute new onset heart failure [per log (unit) increase, adjusted HR (95% CI): 1.28 (0.94, 1.75), P value for interaction <0.001], as well as a better prognostic value for patients with New York Heart Association (NYHA) functional class I-II [per log (unit) increase, adjusted HR (95% CI): 1.67 (1.11, 2.52)] than for those with NYHA functional class III-IV [per log (unit) increase, adjusted HR (95% CI): 1.18 (1.07, 1.31), P value for interaction <0.001]. Baseline sST2 was also a good predictor of the primary endpoint event in patients hospitalized with heart failure at 1 month, 3 months, 1 year and 2 years (area under the curve: 0.789, 0.775, 0.736 and 0.733, respectively), and the best cut-off values were 27.2 ng/ml, 27.1 ng/ml, 27.1 ng/ml and 25.1 ng/ml, respectively. Furthermore, baseline sST2 could provide additional prognostic value when added to baseline NT-proBNP and hs-cTnT (all P values <0.05). According to the category of elevated biomarkers (including NT-proBNP, hs-cTnT, and sST2), patients with three elevated biomarkers had a higher risk of the primary endpoint event compared with those with one or two elevated biomarkers (all P values <0.05). CONCLUSIONS Baseline sST2 remained an independent predictor of adverse events after adjusting for other predictors including NT-proBNP and hs-cTnT, particularly in patients with chronic decompensated heart failure and NYHA functional class I-II. And in the basis of baseline NT-proBNP and hs-cTnT, adding baseline sST2 could provide additional prognostic value for patients hospitalized with heart failure.
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Affiliation(s)
| | - Jingyuan Guan
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Tian L, Li X, Zhang J, Tian X, Wan X, Yao D, Luo B, Huang Q, Deng Y, Xiang W. Influence of Body Mass Index on the Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide Level in Chinese Patients with Heart Failure. Int Heart J 2024; 65:47-54. [PMID: 38296579 DOI: 10.1536/ihj.23-461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an essential biomarker for the prediction of heart failure (HF), but its prognostic ability across body mass index (BMI) categories needs to be clarified. Our study aimed to explore the association between BMI and NT-proBNP and assess the effect of BMI on the prognostic ability of NT-proBNP in Chinese patients with HF. We retrospectively analyzed clinical data from the FuWai Hospital HF Center in Beijing, China. According to the Chinese adult BMI standard, 1,508 patients with HF were classified into four groups: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-23.9 kg/m2, as a reference category), overweight (BMI 24-27.9 kg/m2), and obesity (BMI ≥ 28 kg/m2). NT-proBNP was examined for its prognostic role in adverse events as an endpoint. BMI was independently and negatively associated with NT-proBNP (β = -0.074; P < 0.001), and NT-proBNP levels tended to decrease as BMI increased across the different BMI categories. The results of our study differ from those of other studies of European-American populations. In this study, NT-proBNP was a weak predictor of a 4-year adverse prognosis in underweight patients (BMI < 18.5 kg/m2). In other BMI categories, NT-proBNP was an independent predictor of adverse events in HF. BMI and sex significantly affected the optimal threshold for NT-proBNP to predict the risk of adverse events. There is a negative correlation between BMI and NT-proBNP, and NT-proBNP independently predicts adverse HF events in patients with a BMI of ≥ 18.5 kg/m2. The optimal risk prediction cutoffs are lower in patients who are overweight and obese.
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Affiliation(s)
- Lingfang Tian
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Xiangkui Li
- School of Computer Science and Technology, Harbin University of Science and Technology
| | - Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University
| | - Xinhui Tian
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Xiaolei Wan
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Dengju Yao
- School of Computer Science and Technology, Harbin University of Science and Technology
| | - Bin Luo
- Sichuan Huhui Software CO.,LTD
| | - Qinzhen Huang
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Yansong Deng
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Wei Xiang
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
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Riccardi M, Myhre PL, Zelniker TA, Metra M, Januzzi JL, Inciardi RM. Soluble ST2 in Heart Failure: A Clinical Role beyond B-Type Natriuretic Peptide. J Cardiovasc Dev Dis 2023; 10:468. [PMID: 37998526 PMCID: PMC10672197 DOI: 10.3390/jcdd10110468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
Soluble (s)ST2 has been proposed as a useful biomarker for heart failure (HF) patient management. Myocardial damage or mechanical stress stimulate sST2 release. ST2 competes with a membrane bound receptor (ST2 ligand, or ST2L) for interleukin-33 (IL-33) binding, inhibiting the effects induced by the ST2L/IL-33 interaction so that excessive sST2 may contribute to myocardial fibrosis and ventricular remodeling. Compared to natriuretic peptides (NPs), sST2 concentration is not substantially affected by age, sex, body mass index, kidney function, atrial fibrillation, anemia, or HF etiology, and has low intra-individual variation. Its prognostic role as an independent marker is well reported in the literature. However, there is a gap on its use in combination with NPs, currently the only biomarkers recommended by European and American guidelines for HF management. Reflecting the activation of two distinct biological systems, a benefit from the use of sST2 and NP in combination is advocated. The aim of this review is to report the current scientific knowledge on sST2 in the acute and chronic HF settings with a particular attention to its additive role to natriuretic peptides (NPs).
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Affiliation(s)
- Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.R.); (M.M.)
| | - Peder L. Myhre
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, 1478 Nordbyhagen, Norway;
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
| | - Thomas A. Zelniker
- Department of Internal Medicine II, Division of Cardiology, Center of Cardiovascular Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.R.); (M.M.)
| | - James L. Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, MA 02215, USA;
| | - Riccardo M. Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.R.); (M.M.)
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Prognostic Role of sST2 in Acute Heart Failure and COVID-19 Infection-A Narrative Review on Pathophysiology and Clinical Prospective. Int J Mol Sci 2022; 23:ijms23158230. [PMID: 35897800 PMCID: PMC9331735 DOI: 10.3390/ijms23158230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 12/04/2022] Open
Abstract
The importance of cardiovascular biomarkers in clinical practice increased dramatically in the last years, and the interest extends from the diagnosis purpose to prognostic applications and response to specific treatment. Acute heart failure, ischemic heart failure, and COVID-19 infection represent different clinical settings that are challenging in terms of the proper prognostic establishment. The aim of the present review is to establish the useful role of sST2, the soluble form of the interleukin-1 receptor superfamily (ST2), physiologically involved in the signaling of interleukin-33 (IL-33)-ST2 axis, in the clinical setting of acute heart failure (HF), ischemic heart disease, and SARS-CoV-2 acute infection. Molecular mechanisms associated with the IL33/ST2 signaling pathways are discussed in view of the clinical usefulness of biomarkers to early diagnosis, evaluation therapy to response, and prediction of adverse outcomes in cardiovascular diseases.
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Ip C, Luk KS, Yuen VLC, Chiang L, Chan CK, Ho K, Gong M, Lee TTL, Leung KSK, Roever L, Bazoukis G, Lampropoulos K, Li KHC, Tse G, Liu T. Soluble suppression of tumorigenicity 2 (sST2) for predicting disease severity or mortality outcomes in cardiovascular diseases: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2021; 37:100887. [PMID: 34712771 PMCID: PMC8528731 DOI: 10.1016/j.ijcha.2021.100887] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 01/09/2023]
Abstract
Objectives Soluble suppression of tumorigenicity 2 (sST2) is a member of the interleukin-1 receptor family. It is raised in various cardiovascular diseases, but its value in predicting disease severity or mortality outcomes has been controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether sST2 levels differed between survivors and non-survivors of patients with cardiovascular diseases, and whether elevated sST2 levels correlated with adverse outcomes. Methods PubMed and Embase were searched until 23rd June 2021 for studies that evaluated the relationship between sST2 levels and cardiovascular disease severity or mortality. Results A total of 707 entries were retrieved from both databases, of which 14 studies were included in the final meta-analysis. In acute heart failure, sST2 levels did not differ between survivors and non-survivors (mean difference [MD]: 24.2 ± 13.0 ng/ml; P = 0.06; I2: 95%). Elevated sST2 levels tend to be associated with increased mortality risk (hazard ratio [HR]: 1.12, 95 %CI: 0.99–1.27, P = 0.07; I2: 88%). In chronic heart failure, sST2 levels were higher in non-survivors than in survivors (MD: 0.19 ± 0.04 ng/ml; P = 0.001; I2: 0%) and elevated levels were associated with increased mortality risk (HR: 1.64, 95% CI: 1.27–2.12, P < 0.001; I2: 82%). sST2 levels were significantly higher in severe disease compared to less severe disease (MD: 1.56 ± 0.46 ng/ml; P = 0.001; I2: 98%). Finally, in stable coronary artery disease, sST2 levels were higher in non-survivors than survivors (MD: 3.0 ± 1.1 ng/ml; P = 0.005; I2: 80%) and elevated levels were significantly associated with increased mortality risk (HR: 1.32, 95% CI: 1.04–1.68, P < 0.05; I2: 57%). Conclusions sST2 significantly predicts disease severity and mortality in cardiovascular disease and is a good predictor of mortality in patients with stable coronary artery disease and chronic heart failure.
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Affiliation(s)
- Christina Ip
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - King Sum Luk
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Vincent Lok Cheung Yuen
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Lorraine Chiang
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Ching Ki Chan
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Kevin Ho
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Teddy Tai Loy Lee
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Keith Sai Kit Leung
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Leonardo Roever
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - George Bazoukis
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | | | - Ka Hou Christien Li
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Gary Tse
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.,Kent and Medway Medical School, Canterbury, United Kingdom
| | - Tong Liu
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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A Review of Novel Cardiac Biomarkers in Acute or Chronic Cardiovascular Diseases: The Role of Soluble ST2 (sST2), Lipoprotein-Associated Phospholipase A2 (Lp-PLA2), Myeloperoxidase (MPO), and Procalcitonin (PCT). DISEASE MARKERS 2021; 2021:6258865. [PMID: 34422136 PMCID: PMC8371622 DOI: 10.1155/2021/6258865] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 01/15/2023]
Abstract
While the received traditional predictors are still the mainstay in the diagnosis and prognosis of CVD events, increasing studies have focused on exploring the ancillary effect of biomarkers for the aspiring of precision. Under which circumstances, soluble ST2 (sST2), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and procalcitonin (PCT) have recently emerged as promising markers in the field of both acute and chronic cardiovascular diseases. Existent clinical studies have demonstrated the significant associations between these markers with various CVD outcomes, which further verified the potentiality of markers in helping risk stratification and diagnostic and therapeutic work-up of patients. The current review article is aimed at illuminating the applicability of these four novels and often neglected cardiac biomarkers in common clinical scenarios, including acute myocardial infarction, acute heart failure, and chronic heart failure, especially in the emergency department. By thorough classification, combination, and discussion of biomarkers with clinical and instrumental evaluation, we hope the current study can provide insights into biomarkers and draw more attention to their importance.
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Huang A, Qi X, Hou W, Qi Y, Zhao N, Liu K. Prognostic value of sST2 and NT-proBNP at admission in heart failure with preserved, mid-ranged and reduced ejection fraction. Acta Cardiol 2018; 73:41-48. [PMID: 28944719 DOI: 10.1080/00015385.2017.1325617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to compare sST2 at admission with N-terminal pro B-type natriuretic peptide (NT-proBNP) in prognostic accuracy among different types of heart failure (HF) and clarifying the enhanced prognostic value in patients with HF by the combination of the two biomarkers. METHODS AND RESULTS A total of 164 consecutive patients admitted to our institution for HF were divided into three groups of HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). Circulating sST2 and NT-proBNP were measured using the enzyme-linked immunosorbent assay (ELISA). The sST2 level was only significantly higher in HFrEF when compared with HFpEF. At ROC analysis to one-year adverse events, only sST2 showed predictive value in HFmrEF with an optimal cut-off value of 147.66 ng/ml (AUC 0.697, p = .045, sensitivity 75%, specificity 75.8%), while both NT-proBNP and sST2 showed a significant predictive value in HFpEF (p = .036 vs .042; AUC 0.683, sensitivity 71.4%, specificity 55.6%; AUC 0.677, sensitivity 64.3%, specificity 83.3%) with an optimal cut-off value of 1054.50 pg/ml and 117.80 ng/ml. Multivariate regression analysis suggested that sST2 and NT-proBNP could be biomarkers for predicting 1-year adverse events of HF (OR = 4.384, 95% CI = 1.661-11.570 vs. OR = 3.451, 95% CI = 1.254-9.497). Adverse events occurred frequently within one year both in sST2 and in NT-proBNP above the median. CONCLUSIONS sST2 can provide different prognostic information in distinct types of HF, and even be superior to NT-proBNP. sST2 combined with NT-proBNP can improve predicting accuracy.
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Affiliation(s)
- Anan Huang
- School of Medicine, Nankai University, Tianjin, P.R. China
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, P.R. China
| | - Xin Qi
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, P.R. China
| | - Wenguang Hou
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, P.R. China
| | - Yanfang Qi
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, P.R. China
| | - Na Zhao
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, P.R. China
| | - Keqaing Liu
- Department of Cardiology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, P.R. China
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Meta-Analysis of Soluble Suppression of Tumorigenicity-2 and Prognosis in Acute Heart Failure. JACC-HEART FAILURE 2017; 5:287-296. [DOI: 10.1016/j.jchf.2016.12.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 12/29/2016] [Indexed: 11/23/2022]
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Zhang R, Zhang Y, An T, Guo X, Yin S, Wang Y, Januzzi JL, Cappola TP, Zhang J. Prognostic value of sST2 and galectin-3 for death relative to renal function in patients hospitalized for heart failure. Biomark Med 2016; 9:433-41. [PMID: 25985174 DOI: 10.2217/bmm.15.12] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM To evaluate the associations of soluble ST2 (sST2) and galectin-3 with death relative to renal function in patients with heart failure (HF). METHODS Eleven-hundred-and-sixty-one patients hospitalized for HF with 1-year follow up were enrolled for biomarkers analysis. RESULTS Patients were divided into two groups based on eGFR of either > or ≤60 ml/min/1.73 m(2). sST2 was independently associated with death in both categories of renal function, while galectin-3 lost this significance after addition of NT-proBNP to the model of patients with eGFR ≤60 ml/min/1.73 m(2). CONCLUSION In patients with HF, sST2 improved prediction for death beyond risk factors without being influenced by renal function, however, the prognostic value of galectin-3 is less clear below an eGFR of 60 ml/min/1.73 m(2).
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Affiliation(s)
| | | | | | | | | | | | - James L Januzzi
- 2Division of Cardiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Thomas P Cappola
- 3Penn Cardiovascular Institute, University of Pennsylvania School of Medicine, 415 Curie Blvd, Philadelphia, PA 19104, USA
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