Author + information
- Isaac Teaa,b,
- Chris Watsona,b,
- Eoin O'Connella,b,
- Nadezhda Glezevaa,b,
- Stephanie Jamesa,b,
- Liam Shielsa,b,
- Joe Gallaghera,b,
- James Snidera,b,
- James Januzzia,b,
- Mark Ledwidgea,b and
- Kenneth McDonalda,b
Background: Biomarker based preventative and monitoring strategies are the key to reducing the significant morbidity and mortality caused by cardiovascular (CV) disease. At the forefront, is Soluble ST2 (sST2), a marker of myocyte stretch and fibrosis that has shown prognostic value in many CV diseases. We hypothesized that longitudinal change in serum sST2 concentrations can be used to predict major adverse cardiovascular events (MACE) in an asymptomatic, event free, ambulatory population with risk factors for MACE. MACE is defined here as heart failure, myocardial infarction, arrhythmia, stroke/transient ischemic attack and CV death.
Methods: The study population consisted of 282 patients selected from the longitudinal STOP-HF study. This population is reflective of patients in the community with risk factors for, but without prevalent MACE at enrolment. The study was run in two phases comprising of an initial investigative cohort (n=195) and a subsequent 2:1 (No MACE:MACE) propensity matched verification cohort (n=87). A total of 52 patients developed incident MACE. To further validate the study, B-type natriuretic peptide (BNP), a well validated marker of CV stress was selected as a comparator to sST2. Both serum BNP and sST2 concentrations were quantified in all patients at two time points that had a median separation of 2.5 years apart.
Results: Longitudinal change in sST2 was a statistically significant predictor of incident MACE (AUC 0.60). A one-unit increment in sST2 from baseline to follow up corresponded to an approximately 7.99% increase in the rate of one or more incident MACE. This was independent of the baseline or follow-up sST2 levels. Additionally, patients with significant sST2 rise have a higher chance of experiencing MACE. In contrast, longitudinal change in BNP levels were unable to predict future MACE.
Conclusions: Longitudinal change in sST2 is a robust and valid predictor of incident MACE in ambulatory populations without prevalent MACE at baseline. sST2 also appears to be superior to BNP in this role. Further investigation is warranted to evaluate the clinical utility of longitudinal change in sST2 for risk prediction and event monitoring in various settings.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovations in Cardiovascular Risk Assessment and Reduction
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1235-056
- 2017 American College of Cardiology Foundation