ST2 in patients with severe aortic stenosis and heart failure
Abstract
Background: ST2 is a circulating biomarker that is well established for predicting outcome in heart failure (HF). This is the first study to look at ST2 concentrations in optimally treated patients with stable but significant left ventricular systolic dysfunction (LVSD) compared to patients with severe aortic stenosis (AS).
Methods: Two cohorts were retrospectively studied: 94 patients undergoing transcatheter aortic valve
implantation for severe AS (63 with normal ejection fraction [EF] and 31 with reduced EF), and 50 patients with severe LVSD from non-valvular causes. ST2 pre-procedural samples were taken, and repeated again at 3 and 6 months. Patients were followed-up for 2 years. Data was analyzed using SPSS software.
Results: Baseline concentrations of soluble ST2 did not differ significantly between the HF group and AS group with normal EF (EF ≥ 50%). However, in the AS group with a low EF (EF < 50%) ST2 concentrations
were significantly higher that the HF group (p = 0.009). New York Heart Association class IV HF, baseline N-terminal pro-B-type natriuretic peptide and gender were all independent predictors of soluble ST2 (sST2) baseline concentrations.
Conclusions: Raised ST2 concentrations in the context of severe AS may be a marker for subclinical or clinical left ventricular dysfunction. More research is required to assess its use for assessment of prognosis and response to treatment.
Keywords: ST2biomarkersaortic stenosistranscatheter aortic valve implantationheart failure
References
- Januzzi JL, Mebazaa A, Di Somma S. ST2 and prognosis in acutely decompensated heart failure: the International ST2 Consensus Panel. Am J Cardiol. 2015; 115(7 Suppl): 26B–31B.
- Zhang R, Zhang Y, An T, et al. Prognostic value of sST2 and galectin-3 for death relative to renal function in patients hospitalized for heart failure. Biomark Med. 2015; 9(5): 433–441.
- Ky B, French B, McCloskey K, et al. High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure. Circ Heart Fail. 2011; 4(2): 180–187.
- Januzzi JL, Pascual-Figal D, Daniels LB. ST2 testing for chronic heart failure therapy monitoring: the International ST2 Consensus Panel. Am J Cardiol. 2015; 115(7 Suppl): 70B–75B.
- Piper SE, Sherwood RA, Amin-Youssef GF, et al. Serial soluble ST2 for the monitoring of pharmacologically optimised chronic stable heart failure. Int J Cardiol. 2015; 178: 284–291.
- Bartunek J, Delrue L, Van Durme F, et al. Nonmyocardial production of ST2 protein in human hypertrophy and failure is related to diastolic load. J Am Coll Cardiol. 2008; 52(25): 2166–2174.
- Shimpo M, Morrow DA, Weinberg EO, et al. Expression and regulation of ST2, an interleukin-1 receptor family member, in cardiomyocytes and myocardial infarction. Circulation. 2002; 106(23): 2961–2966.
- McMurray JJV, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012; 14(8): 803–869.
- R & D Systems. Human ST2/IL-33 R Quantikine ELISA Kit. https://www.rndsystems.com/products/human-st2-il-33-r-quantikine-elisa-kit_dst200 (Accessed 03/11/2018).
- Horstkotte D, Loogen F. The natural history of aortic valve stenosis. Eur Heart J. 1988; 9 Suppl E: 57–64.
- Bayes-Genis A, Januzzi JL, Gaggin HK, et al. ST2 pathogenetic profile in ambulatory heart failure patients. J Card Fail. 2015; 21(4): 355–361.
- Sawada H, Naito Y, Hirotani S, et al. Expression of interleukin-33 and ST2 in nonrheumatic aortic valve stenosis. Int J Cardiol. 2013; 168(1): 529–531.
- Carabello BA. Is it ever too late to operate on the patient with valvular heart disease? J Am Coll Cardiol. 2004; 44(2): 376–383.
- Lancellotti P, Dulgheru R, Magne J, et al. Elevated plasma soluble ST2 is associated with heart failure symptoms and outcome in aortic stenosis. PLoS One. 2015; 10(9): e0138940.
- Ibrahim N, Januzzi JL. The potential role of natriuretic peptides and other biomarkers in heart failure diagnosis, prognosis and management. Expert Rev Cardiovasc Ther. 2015; 13(9): 1017–1030.
