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Eur J Heart Fail. 2020 Jan 9. doi: 10.1002/ejhf.1701. [Epub ahead of print]

Circulating levels and prognostic value of soluble ST2 in heart failure are less influenced by age than N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T.

Author information

1
Scuola Superiore Sant'Anna, Pisa, Italy.
2
Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA.
3
Fondazione Toscana G. Monasterio, Pisa, Italy.
4
University of Otago, Dunedin, New Zealand.
5
National University of Singapore, Singapore.
6
IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
7
University of Minnesota, Minneapolis, MN, USA.
8
VA Medical Centre, Minneapolis, MN, USA.
9
Oslo University Hospital, Oslo, Norway.
10
University of Oslo, Oslo, Norway.
11
University of Tromsø, Tromsø, Norway.
12
Maastricht University Medical Centre, Maastricht, The Netherlands.
13
Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
14
University Medical Centre Groningen, Groningen, The Netherlands.
15
Fukushima Medical University, Fukushima, Japan.
16
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
17
Uppsala University, Uppsala, Sweden.
18
Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria.
19
University of Auckland, Auckland, New Zealand.
20
Changi General Hospital, Singapore.
21
Tan Tock Seng Hospital, Singapore.
22
Khoo Teck Puat Hospital, Singapore.
23
Singapore General Hospital, Singapore.
24
University of Otago, Christchurch, New Zealand.

Abstract

AIMS:

N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT) and soluble suppression of tumorigenesis-2 (sST2) predict outcome in chronic heart failure (HF). We assessed the influence of age on circulating levels and prognostic significance of these biomarkers.

METHODS AND RESULTS:

Individual data from 5301 patients with chronic HF and NT-proBNP, hs-TnT, and sST2 data were evaluated. Patients were stratified according to age: <60 years (n = 1332, 25%), 60-69 years (n = 1628, 31%), 70-79 years (n = 1662, 31%), and ≥ 80 years (n = 679, 13%). Patients (median age 66 years, 75% men, median left ventricular ejection fraction 28%, 64% with ischaemic HF) had median NT-proBNP 1564 ng/L, hs-TnT 21 ng/L, and sST2 29 ng/mL. Age independently predicted NT-proBNP and hs-TnT, but not sST2. The best NT-proBNP and hs-TnT cut-offs for 1-year and 5-year all-cause and cardiovascular mortality and 1- to 12-month HF hospitalization increased with age, while the best sST2 cut-offs did not. When stratifying patients according to age- and outcome-specific cut-offs, this stratification yielded independent prognostic significance over NT-proBNP levels only, or the composite of NT-proBNP and hs-TnT, and improved risk prediction for most endpoints. Finally, absolute NT-proBNP, hs-TnT, and sST2 levels predicted outcomes independent of age, sex, left ventricular ejection fraction category, ethnic group, and other variables.

CONCLUSIONS:

Soluble ST2 is less influenced by age than NT-proBNP or hs-TnT; all these biomarkers predict outcome regardless of age. The use of age- and outcome-specific cut-offs of NT-proBNP, hs-TnT and sST2 allows more accurate risk stratification than NT-proBNP alone or the combination of NT-proBNP and hs-TnT.

KEYWORDS:

Age; Biomarkers; Heart failure; Prognosis; sST2

PMID:
31919929
DOI:
10.1002/ejhf.1701

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