Serum ST2 and hospitalization rates in Caucasian and African American outpatients with heart failure

• Type of Material: Article
• Authors: Panagiotis Savvoulidis, Royal Brompton & Harefield NHS Foundation Trust; James V Snider, Critical Diagnostics; Sahil Rawal, Stony Brook University; Alanna Morris, Emory University; Javed Butler, Emory University; Vasiliki V Georgiopoulou, Emory University; Andreas Kalogeropoulos, Emory University
• Language: English
• Date: 2020-04-01
• Publisher: ELSEVIER IRELAND LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijcard.2019.11.002
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF CARDIOLOGY
• Volume: 304
• Start Page: 116
• End Page: 121
• Grant/Funding Information: This project was funded by an Emory University Heart and Vascular Board grant and supported in part by Public Health Service grants UL1 RR025008, KL2 RR025009, and TL1 RR025010 from the Clinical and Translational Science Award program, National Institutes of Health, and National Center for Research Resources. Critical Diagnostics (San Diego, CA) measured ST2 concentrations in blinded samples and had no role in the design of the study or the analysis and interpretation of the data.
• Keywords: OUTCOMES; SOLUBLE ST2; RECURRENT EVENTS; EUROPEAN-SOCIETY; EJECTION FRACTION; Mortality; MORTALITY; Cardiovascular System & Cardiology; Outcomes; Life Sciences & Biomedicine; TUMORIGENICITY-2; SUPPRESSION; AMBULATORY PATIENTS; Science & Technology; Suppression of tumorigenicity 2 (ST2); Heart failure; PROGNOSTIC VALUE; Cardiac & Cardiovascular Systems; Hospitalization

Abstract

Background: Limited data exist on the association between circulating suppression of tumorigenicity 2 (ST2) and recurrent hospitalizations and emergency department (ED) encounters in outpatients with heart failure (HF). In addition, data on ST2 in African American patients with HF are scarce. Methods: We evaluated 307 outpatients with HF (age, 57 ± 12 years; 64.2% men; 51.5% Caucasian, 45.6% African American; median ejection fraction, 35%; ischemic etiology, 41.4%). Median ST2 was 37.8 ng/mL (29.6–51.4). Results: After a median of 3.1 years, there were 584 hospitalizations (224 for HF) and 335 ED visits (80 for HF). Patients (N = 176; 57.3%) with elevated (>35 ng/mL) ST2 had 2-fold higher hospitalization rates in adjusted models (rate ratio [RR] 1.97; 95% CI 1.38–2.82; P < 0.001), driven by 3.5-fold higher HF hospitalization rates (adjusted RR 3.56; 95% CI 1.69–7.49; P < 0.001). These associations persisted after adjusting for baseline B-type natriuretic peptide levels. Findings were similar for elevated ST2 and ED visit rates. Elevated ST2 was associated with the composite of death or HF hospitalization (109 patients; 3-year estimate: 35.4%); risk was 5-fold higher in the first 6 months but declined gradually. The higher hospitalization rates and composite endpoint risk associated with elevated ST2 was similar in African Americans and Caucasians. In landmark analyses in a subset of patients, 6-month (N = 112) and 12-month (N = 149) changes in ST2 levels from baseline added prognostic information. Conclusions: Elevated ST2 in outpatients with HF portends higher healthcare resources utilization and higher risk for accelerated disease progression, regardless of race, especially in the first 6 months.