Author + information
- Received May 24, 2013
- Revision received July 17, 2013
- Accepted July 23, 2013
- Published online January 21, 2014.
- Antoni Bayes-Genis, MD, PhD∗,†∗ (, )
- Marta de Antonio, MD∗,†,
- Joan Vila, MSc‡,§,
- Judith Peñafiel, BSc‡,§,
- Amparo Galán, MD, PhD‖,
- Jaume Barallat, MD‖,
- Elisabet Zamora, MD, PhD∗,†,
- Agustin Urrutia, MD, PhD∗,† and
- Josep Lupón, MD, PhD∗,†
- ∗Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- †Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- ‡Hospital del Mar Medical Research Institute, Barcelona, Spain
- §CIBER Epidemiology and Public Health, Barcelona, Spain
- ‖Biochemistry Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- ↵∗Reprint requests and correspondence:
Dr. Antoni Bayes-Genis, Department of Cardiology, Hospital Germans Trias I Pujol, Crta. Canyet s/n, Badalona, Barcelona 08916, Spain.
Objectives ST2 and galectin-3 (Gal-3) were compared head-to-head for long-term risk stratification in an ambulatory heart failure (HF) population on top of other risk factors including N-terminal pro–B-type natriuretic peptide.
Background ST2 and Gal-3 are promising biomarkers of myocardial fibrosis and remodeling in HF.
Methods This cohort study included 876 patients (median age: 70 years, median left ventricular ejection fraction: 34%). The 2 biomarkers were evaluated relative to conventional assessment (11 risk factors) plus N-terminal pro–B-type natriuretic peptide in terms of discrimination, calibration, and reclassification analysis. Endpoints were 5-year all-cause and cardiovascular mortality, and the combined all-cause death/HF hospitalization.
Results During a median follow-up of 4.2 years (5.9 for alive patients), 392 patients died. In bivariate analysis, Gal-3 and ST2 were independent variables for all endpoints. In multivariate analysis, only ST2 remained independently associated with cardiovascular mortality (hazard ratio: 1.27, 95% confidence interval [CI]: 1.05 to 1.53, p = 0.014). Incorporation of ST2 into a full-adjusted model for all-cause mortality (including clinical variables and N-terminal pro–B-type natriuretic peptide) improved discrimination (C-statistic: 0.77, p = 0.004) and calibration, and reclassified significantly better (integrated discrimination improvement: 1.5, 95% CI: 0.5 to 2.5, p = 0.003; net reclassification index: 9.4, 95% CI: 4.8 to 14.1, p < 0.001). Incorporation of Gal-3 showed no significant increase in discrimination or reclassification and worse calibration metrics. On direct model comparison, ST2 was superior to Gal-3.
Conclusions Head-to-head comparison of fibrosis biomarkers ST2 and Gal-3 in chronic HF revealed superiority of ST2 over Gal-3 in risk stratification. The incremental predictive contribution of Gal-3 to existing clinical risk factors was trivial.
ST2 assays were performed by Critical Diagnostics; N-terminal pro–B-type natriuretic peptide assays were provided by Roche Diagnostics; and galectin 3 assays were partially provided by BioMerieux. Dr. Bayes-Genis has received lecture honoraria from Roche Diagnostics and Critical Diagnostics; and he owns stock in Critical Diagnostics. Dr. de Antonio has received a research grant from the Catalan Society of Cardiology. Dr. Lupón owns stock in Critical Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 24, 2013.
- Revision received July 17, 2013.
- Accepted July 23, 2013.