Heart failure therapy-induced early ST2 changes may offer long-term therapy guidance.
J Card Fail
; 19(12): 821-8, 2013 Dec.
Article
em En
| MEDLINE
| ID: mdl-24239955
ABSTRACT
BACKGROUND:
Biomarkers may help to monitor and tailor treatment in patients with acute heart failure (AHF). METHODS ANDRESULTS:
Levels of ST2, a novel biomarker integrating hypervolemic cardiac strain and proinflammatory signals, were measured at presentation to the emergency department (ED) and after 48 hours in 207 patients with AHF. Patients were stratified according to their early ST2 response (responders ST2 decrease ≥25%; nonresponders ST2 decrease <25%) and beta-blocker, renin-angiotensin-aldosterone system (RAAS) blockade, or diuretic treatment status at hospital discharge. We assessed the utility of ST2 levels and its changes to predict long-term mortality and the interaction between ST2 levels, treatment at discharge, and 1-year mortality. ST2 levels were higher in nonsurvivors than in survivors (median 108 vs 69 ng/mL; P < .01) and decreased significantly during the 1st 48 hours (median decrease 33%). ST2 decrease was less in nonsurvivors compared with survivors (median -25% vs -42%; P < .01). In Cox regression, early ST2 changes independently predicted 1-year mortality (hazard ratio 1.07 for every increase of 10%; P = .02). RAAS blockers at discharge were associated with survival independently from ST2 response, whereas the association of beta-blockers with survival differed markedly according to ST2 response, with beneficial effects restricted to ST2 nonresponders (P interaction = .04). A similar, albeit nonsignificant, trend was observed for diuretics (P interaction = .11).CONCLUSIONS:
ED and serial ST2 measurements are independent predictors of 1-year mortality in AHF.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Guias de Prática Clínica como Assunto
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Receptores de Superfície Celular
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Insuficiência Cardíaca
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article