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Soluble ST2 in ambulatory patients with heart failure: Association with functional capacity and long-term outcomes.

Publication ,  Journal Article
Felker, GM; Fiuzat, M; Thompson, V; Shaw, LK; Neely, ML; Adams, KF; Whellan, DJ; Donahue, MP; Ahmad, T; Kitzman, DW; Piña, IL; Zannad, F ...
Published in: Circ Heart Fail
November 2013

BACKGROUND: ST2 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) study-a multicenter, randomized study of exercise training in HF. METHODS AND RESULTS: HF-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. CONCLUSIONS: ST2 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. CLINICAL TRIAL INFORMATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.

Duke Scholars

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

November 2013

Volume

6

Issue

6

Start / End Page

1172 / 1179

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Time Factors
  • Stroke Volume
  • Receptors, Interleukin-1
  • Receptors, Cell Surface
  • Prognosis
  • Outpatients
  • Middle Aged
  • Male
  • Interleukin-1 Receptor-Like 1 Protein
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Felker, G. M., Fiuzat, M., Thompson, V., Shaw, L. K., Neely, M. L., Adams, K. F., … O’Connor, C. M. (2013). Soluble ST2 in ambulatory patients with heart failure: Association with functional capacity and long-term outcomes. Circ Heart Fail, 6(6), 1172–1179. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000207

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

November 2013

Volume

6

Issue

6

Start / End Page

1172 / 1179

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Time Factors
  • Stroke Volume
  • Receptors, Interleukin-1
  • Receptors, Cell Surface
  • Prognosis
  • Outpatients
  • Middle Aged
  • Male
  • Interleukin-1 Receptor-Like 1 Protein