ISSN 2996-8215
International Journal of Cardiology | Vol. 14, No. 2, February 2023 | pp. 9–16
DOI: 10.46882/2023/IJC/000166
Original Research Article
Prognostic Value of Admission Soluble ST2 in Heart Failure with Preserved Ejection Fraction outpatients
Stefan de Vries¹, Anika Janssen¹, Jan de Jong²
¹Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
²Division of Cardiovascular Medicine, Leiden University Medical Center, Leiden, Netherlands
Abstract:
Heart failure with preserved ejection fraction (HFpEF) lacks well-validated biomarkers for long-term risk stratification compared to heart failure with reduced ejection fraction. Soluble ST2 (sST2) is an interleukin-1 receptor family member reflecting myocardial strain and fibrosis pathways. This study evaluated the long-term prognostic value of plasma sST2 levels in a prospective cohort of stable HFpEF patients. We enrolled 195 patients with documented HFpEF (LVEF greater than or equal to 50%). Plasma sST2 concentrations were measured at baseline during standard outpatient follow-up. The primary endpoint was a composite of cardiovascular mortality or heart failure hospitalization over a 24-month period. High baseline sST2 (defined as greater than 35 ng/mL) was identified in 38.5% of the study population. At 24 months, the primary composite endpoint occurred in 48 patients (24.6%). Survival analysis showed a significantly lower event-free survival rate in the high sST2 group compared to the low sST2 group (38.7% vs. 15.8%, log-rank p < 0.001). After adjusting for age, body mass index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP), multivariable Cox proportional hazards regression confirmed that elevated sST2 remained a powerful independent predictor of the composite outcome (hazard ratio: 2.12, 95% CI: 1.34–3.35, p = 0.001). Circulating soluble ST2 levels provide robust, independent prognostic data in patients with stable heart failure and preserved ejection fraction, outperforming traditional clinical metrics for predicting long-term decompensation.
Keywords: Heart failure with preserved ejection fraction, Soluble ST2, Biomarkers, Prognosis, Cardiovascular mortality, Heart failure hospitalization
Received: November 05, 2022; Revised: December 18, 2022; Accepted: January 10, 2023; Published: February 20, 2023