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Original Articles

Serum Levels of the Interleukin-1 Receptor Family Member ST2, Cardiac Structure and Function, and Long-Term Mortality in Patients With Acute Dyspnea

Ravi V. Shah, MD; Annabel A. Chen-Tournoux, MD; Michael H. Picard, MD; Roland R.J. van Kimmenade, MD, PhD and James L. Januzzi, MD, FACC

From the Department of Medicine (R.V.S., A.C.T., M.H.P., J.L.J.), Cardiology Division (A.C.T., M.H.P., J.L.J.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Cardiology (R.R.J.v.K.), University Hospital Maastricht, AZ Maastricht, The Netherlands.

Correspondence to James L. Januzzi, MD, FACC, Massachusetts General Hospital, 32 Fruit Street, Yawkey 5984, Boston, MA 02114. E-mail jjanuzzi{at}partners.org

Received November 4, 2008; accepted April 23, 2009.

Background— ST2, a biomarker of cardiomyocyte stretch, powerfully predicts poor outcomes in patients with acute dyspnea, but nothing is known about associations between soluble ST2 (sST2) and cardiac structure and function, or whether sST2 retains prognostic meaning in the context of such measures.

Methods and Results— One hundred thirty-four dyspneic patients with and without decompensated heart failure had echocardiography during index admission and vital status was ascertained at 4 years. Echocardiographic and clinical correlates of sST2 as well as independent predictors of death at 4 years were identified. sST2 correlated with left ventricular end-systolic dimensions/volumes and left ventricular ejection fraction. sST2 was inversely associated with right ventricular fractional area change (=–0.18; P=0.046), higher right ventricular systolic pressure (=0.26; P=0.005), and right ventricular hypokinesis (P<0.001) and was correlated with tissue Doppler Ea wave peak velocity, but not to other indices of diastolic function. In multivariate regression, independent predictors of sST2 included right ventricular systolic pressure (t=2.29; P=0.002), left ventricular ejection fraction (t=–2.15; P=0.05) and dimensions (end systolic, t=2.57; end diastolic, t=2.98; both P<0.05), amino-terminal pro-B-type natriuretic peptide (t=3.31; P=0.009), heart rate (t=2.59; P=0.01), and presence of jugular venous distension (t=2.00; P=0.05). In a Cox proportional hazards model that included echocardiographic results and other biomarkers, sST2 independently predicted death at 4 years (hazard ratio=2.70; P=0.003).

Conclusions— Among dyspneic patients with and without acute heart failure, sST2 concentrations are associated with prevalent cardiac abnormalities on echocardiography, a more decompensated hemodynamic profile and are associated with long-term mortality, independent of echocardiographic, clinical, or other biochemical markers of risk.

Key Words: echocardiography • heart failure • biomarker • prognosis

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CLINICAL PERSPECTIVE

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				S. A. Moore and J. L. Januzzi Jr Found in Translation: Soluble ST2 and Heart Disease J. Am. Coll. Cardiol., January 19, 2010; 55(3): 251 - 253. [Full Text] [PDF]