Circulating Soluble ST2 Predicts All-Cause Mortality in Severe Heart Failure Patients with an Implantable Cardioverter Defibrillator

Zhi-Wei Hou; Hai-Bo Yu; Yan-Chun Liang; Yang Gao; Guo-Qing Xu; Min Wu; Zhu Mei; Zu-Lu Wang; Zhi-Guo Li; Yu-Ying Li; Hai-Xu Song; Jia-Yin Li; Ya-Ling Han

doi:10.1155/2020/4375651

Circulating Soluble ST2 Predicts All-Cause Mortality in Severe Heart Failure Patients with an Implantable Cardioverter Defibrillator

Cardiol Res Pract. 2020 Nov 17:2020:4375651. doi: 10.1155/2020/4375651. eCollection 2020.

Authors

Zhi-Wei Hou¹, Hai-Bo Yu¹, Yan-Chun Liang¹, Yang Gao¹, Guo-Qing Xu¹, Min Wu¹, Zhu Mei¹, Zu-Lu Wang¹, Zhi-Guo Li¹, Yu-Ying Li^{1

2}, Hai-Xu Song^{1

3}, Jia-Yin Li^{1

4}, Ya-Ling Han¹

Affiliations

¹ Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang 110016, China.
² Huazhong University of Science and Technology, Wuhan 430030, China.
³ Air Force Medical University, Xian 710000, China.
⁴ Northeastern University, Shenyang 110016, China.

Abstract

Background: Heart failure (HF) is the terminal stage of all cardiovascular events. Although implantable cardioverter defibrillator (ICD) therapies have reduced mortality among the high-risk HF population, it is necessary to determine whether certain factors can predict mortality even after cardiac device implantation. Growth stimulation expressed gene 2 (ST2) is an emerging biomarker for HF patient stratification in different clinical settings.

Aims: This study aimed to investigate the relationship between baseline soluble ST2 (sST2) levels in serum and the clinical outcomes of high-risk HF patients with device implantation.

Methods: Between January 2017 and August 2018, we prospectively recruited consecutive patients implanted with an ICD for heart failure, with LVEF ≤35% as recommended, and analyzed the basic characteristics, baseline serum sST2, and NT-proBNP levels, with at least 1-year follow-up. All-cause mortality was the primary endpoint.

Results: During a 643-day follow-up, all-cause mortality occurred in 16 of 150 patients (10.67%). Incidence of all-cause mortality increased significantly in patients with sST2 levels above 34.98846 ng/ml (16.00% vs. 5.33%, P = 0.034). After adjusting the model (age, gender, device implantation, prevention of sudden death, LVEDD, LVEF, WBC and CLBBB, hsTNT, etiology, and eGFR) and the model combined with NT-proBNP, the risk of all-cause death was increased by 2.5% and 1.9%, respectively, per ng/ml of sST2. The best sST2 cutoff for predicting all-cause death was 43.42671 ng/ml (area under the curve: 0.72, sensitive: 0.69, and specificity: 0.69). Compared to patients with sST2 levels below 43.42671 ng/ml, the risk of all-cause mortality was higher in those with values above the threshold (5.1% vs. 21.2%, P = 0.002). ST2 level ≥43.42671 ng/ml was an independent predictor of all-cause mortality (HR: 3.30 [95% CI 1.02-10.67]). Age (HR: 1.06 [95% CI: 1.01-1.12]) and increased NT-proBNP per 100 (HR: 1.02 [95% CI: 1.01-1.03]) were also associated with all-cause mortality in ICD patients.

Conclusions: sST2 level was associated with risk of all-cause mortality, and a threshold of 43.43 ng/ml showed good distinguishing performance to predict all-cause mortality in patients with severe heart failure, recommended for ICD implantation. Patients with sST2 levels more than 43.42671 ng/ml even after ICD implantation should therefore be monitored carefully.