Abstract
BackgroundST2 is involved in cardioprotective signaling in the myocardium and has been identified as a potentially promising biomarker in heart failure (HF). We evaluated ST2 levels and their association with functional capacity and long-term clinical outcomes in a cohort of ambulatory patients with HF enrolled in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) studya multicenter, randomized study of exercise training in HF. Methods and ResultsHF-ACTION randomized 2331 patients with left ventricular ejection fraction <0.35 and New York Heart Association class II to 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, 1.48; P<0.0001), cardiovascular death or HF hospitalization (hazard ratio, 2.14; P<0.0001), and all-cause mortality (hazard ratio, 2.33; P<0.0001; all hazard ratios for log2 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. ConclusionsST2 was modestly associated with functional capacity and was significantly associated with outcomes in a well-treated cohort of ambulatory patients with HF although it did not significantly affect reclassification of risk.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1172-1179 |
| Number of pages | 8 |
| Journal | Circulation: Heart Failure |
| Volume | 6 |
| Issue number | 6 |
| DOIs | |
| State | Published - 2013 |
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Keywords
- Biomarkers
- Heart failure
- Prognosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
Cite this
Soluble ST2 in Ambulatory Patients with Heart Failure Association with Functional Capacity and Long-Term Outcomes. / Felker, G. Michael; Fiuzat, Mona; Thompson, Vivian; Shaw, Linda K.; Neely, Megan L.; Adams, Kirkwood F.; Whellan, David J.; Donahue, Mark P.; Ahmad, Tariq; Kitzman, Dalane W.; Pina, Ileana L.; Zannad, Faiez; Kraus, William E.; O Connor, Christopher M.
In: Circulation: Heart Failure, Vol. 6, No. 6, 2013, p. 1172-1179.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Soluble ST2 in Ambulatory Patients with Heart Failure Association with Functional Capacity and Long-Term Outcomes
AU - Felker, G. Michael
AU - Fiuzat, Mona
AU - Thompson, Vivian
AU - Shaw, Linda K.
AU - Neely, Megan L.
AU - Adams, Kirkwood F.
AU - Whellan, David J.
AU - Donahue, Mark P.
AU - Ahmad, Tariq
AU - Kitzman, Dalane W.
AU - Pina, Ileana L.
AU - Zannad, Faiez
AU - Kraus, William E.
AU - O Connor, Christopher M.
PY - 2013
Y1 - 2013
N2 - BackgroundST2 is involved in cardioprotective signaling in the myocardium and has been identified as a potentially promising biomarker in heart failure (HF). We evaluated ST2 levels and their association with functional capacity and long-term clinical outcomes in a cohort of ambulatory patients with HF enrolled in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) studya multicenter, randomized study of exercise training in HF. Methods and ResultsHF-ACTION randomized 2331 patients with left ventricular ejection fraction <0.35 and New York Heart Association class II to 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, 1.48; P<0.0001), cardiovascular death or HF hospitalization (hazard ratio, 2.14; P<0.0001), and all-cause mortality (hazard ratio, 2.33; P<0.0001; all hazard ratios for log2 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. ConclusionsST2 was modestly associated with functional capacity and was significantly associated with outcomes in a well-treated cohort of ambulatory patients with HF although it did not significantly affect reclassification of risk.
AB - BackgroundST2 is involved in cardioprotective signaling in the myocardium and has been identified as a potentially promising biomarker in heart failure (HF). We evaluated ST2 levels and their association with functional capacity and long-term clinical outcomes in a cohort of ambulatory patients with HF enrolled in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) studya multicenter, randomized study of exercise training in HF. Methods and ResultsHF-ACTION randomized 2331 patients with left ventricular ejection fraction <0.35 and New York Heart Association class II to 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, 1.48; P<0.0001), cardiovascular death or HF hospitalization (hazard ratio, 2.14; P<0.0001), and all-cause mortality (hazard ratio, 2.33; P<0.0001; all hazard ratios for log2 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. ConclusionsST2 was modestly associated with functional capacity and was significantly associated with outcomes in a well-treated cohort of ambulatory patients with HF although it did not significantly affect reclassification of risk.
KW - Biomarkers
KW - Heart failure
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=84892644062&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892644062&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.113.000207
DO - 10.1161/CIRCHEARTFAILURE.113.000207
M3 - Article
C2 - 24103327
AN - SCOPUS:84892644062
VL - 6
SP - 1172
EP - 1179
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
SN - 1941-3297
IS - 6
ER -