Soluble ST2 in ambulatory patients with heart failure: Association with functional capacity and long-term outcomes.
Soluble ST2 in ambulatory patients with heart failure: Association with functional capacity and long-term outcomes.
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DOI：
10.1161/circheartfailure.113.000207
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发表时间：
2013-11
期刊：
影响因子：
--
通讯作者：
O'Connor CM
中科院分区：
文献类型：
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作者：
Felker GM;Fiuzat M;Thompson V;Shaw LK;Neely ML;Adams KF;Whellan DJ;Donahue MP;Ahmad T;Kitzman DW;Piña IL;Zannad F;Kraus WE;O'Connor CM
ST2 is involved in cardioprotective signaling in the myocardium and has been identified as a potentially promising biomarker in HF. We evaluated ST2 levels and their association with functional capacity and long-term clinical outcomes in a cohort of ambulatory heart failure (HF) patients enrolled in the HF-ACTION study—a multicenter, randomized study of exercise training in HF. HF-ACTION randomized 2331 patients with left ventricular ejection fraction <0.35 and New York Heart Association class II–IV HF to either exercise training or usual care. ST2 was analyzed in a subset of 910 patients with evaluable plasma samples. Correlations and Cox models were used to assess the relationship among ST2, functional capacity, and long-term outcomes. The median baseline ST2 level was 23.7 ng/mL (interquartile range, 18.6–31.8). ST2 was modestly associated with measures of functional capacity. In univariable analysis, ST2 was significantly associated with death or hospitalization (hazard ratio [HR], 1.48; p<0.0001), cardiovascular death or HF hospitalization (HR, 2.14; p<0.0001), and all-cause mortality (HR, 2.33; p<0.0001)(all HRs for log-base2 ng/mL). In multivariable models, ST2 remained independently associated with outcomes after adjustment for clinical variables and amino-terminal pro–B-type natriuretic peptide. However, ST2 did not add significantly to reclassification of risk as assessed by changes in the C statistic, net reclassification improvement, and integrated discrimination improvement. ST2 was modestly associated with functional capacity and was significantly associated with outcomes in a well-treated cohort of ambulatory HF patients, although it did not significantly affect reclassification of risk.
