ISSN 2996-8215
International Journal of Cardiology | Vol. 3, No. 8, August 2012 | pp. 57–64
DOI: 10.46882/2012/IJC/000041
Original Research Article
Prognostic Value of Soluble ST2 in Patients with Acute Decompensated Heart Failure and Renal Dysfunction
Carlos Mendoza¹, Javier Delgado¹, Manuel Almería²
¹Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
²Division of Cardiovascular Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Abstract:
Acute decompensated heart failure (ADHF) complicated by renal impairment, known as cardiorenal syndrome, carries an unfavorable prognosis. Soluble ST2 (sST2) is a biomarker of myocardial strain and fibrosis that is not significantly cleared by the kidneys, unlike natriuretic peptides. This study evaluated the prognostic value of sST2 in ADHF patients across varying levels of renal function. We prospectively enrolled 240 patients admitted for ADHF. Plasma sST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured within 24 hours of admission. Renal function was assessed using the estimated glomerular filtration rate (eGFR). The primary endpoint was a composite of all-cause mortality or heart failure rehospitalization at 12 months. Patients were stratified into two groups: eGFR less than 60 mL/min/1.73m² (n = 112) and eGFR greater than or equal to 60 mL/min/1.73m² (n = 128). Elevated sST2 (greater than 35 ng/mL) was observed in 68% of the cohort. At 12 months, the primary endpoint occurred in 74 patients (30.8%). In patients with renal dysfunction (eGFR less than 60 mL/min/1.73m²), sST2 remained a powerful independent predictor of the primary composite endpoint (hazard ratio: 2.14, 95% CI: 1.34–3.42, p = 0.001) after adjusting for clinical covariates and NT-proBNP. Conversely, the predictive value of NT-proBNP was attenuated in this renal subgroup (hazard ratio: 1.28, p = 0.12). Soluble ST2 provides robust, independent prognostic utility in patients with acute decompensated heart failure and concurrent renal impairment, outperforming traditional natriuretic peptides in this high-risk cardiorenal cohort.
Keywords: Acute decompensated heart failure, Soluble ST2, Biomarkers, Cardiorenal syndrome, Renal impairment, Prognosis
Received: May 10, 2012; Revised: June 22, 2012; Accepted: July 12, 2012; Published: August 18, 2012
Citation: International Journal of Cardiology, 2012, Vol. 3, No. 8, pp. 57–64, DOI: 10.46882/2012/IJC/000041