Antoni Bayes-Genis1, Marta de Antonio2, Joan Vila3, Judith Peñafiel3, Amparo Galán4, Jaume Barallat4, Elisabet Zamora2, Agustin Urrutia2, Josep Lupón2. 1. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: grupicrec@gmail.com. 2. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. 3. Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER Epidemiology and Public Health, Barcelona, Spain. 4. Biochemistry Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Abstract
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.
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.
Authors: Tariq Ahmad; Mona Fiuzat; Benjamin Neely; Megan L Neely; Michael J Pencina; William E Kraus; Faiez Zannad; David J Whellan; Mark P Donahue; Ileana L Piña; Kirkwood F Adams; Dalane W Kitzman; Christopher M O'Connor; G Michael Felker Journal: JACC Heart Fail Date: 2014-06 Impact factor: 12.035
Authors: Panagiotis Savvoulidis; James V Snider; Sahil Rawal; Alanna A Morris; Javed Butler; Vasiliki V Georgiopoulou; Andreas P Kalogeropoulos Journal: Int J Cardiol Date: 2019-11-06 Impact factor: 4.164
Authors: Dipal M Patel; Heather Thiessen-Philbrook; Jeremiah R Brown; Eric McArthur; Dennis G Moledina; Sherry G Mansour; Michael G Shlipak; Jay L Koyner; Peter Kavsak; Richard P Whitlock; Allen D Everett; David J Malenka; Amit X Garg; Steven G Coca; Chirag R Parikh Journal: Am Heart J Date: 2019-12-03 Impact factor: 4.749
Authors: Benjamin French; Le Wang; Bonnie Ky; Jeffrey Brandimarto; Anupam Basuray; James C Fang; Nancy K Sweitzer; Thomas P Cappola Journal: J Card Fail Date: 2015-11-10 Impact factor: 5.712