Josep Lupón1, Sandra Sanders-van Wijk2, James L Januzzi3, Marta de Antonio4, Hanna K Gaggin3, Matthias Pfisterer5, Amparo Galán6, Ravi Shah3, Hans-Peter Brunner-La Rocca2, Antoni Bayes-Genis7. 1. Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. 2. Department of Cardiology, Maastricht University Medical Center MUMC, Maastricht, The Netherlands. 3. Cardiology Division, Massachusetts General Hospital, Boston, MA, USA. 4. Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 5. University Hospital Basel, Switzerland. 6. Servei de Bioquímica, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 7. Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: abayesgenis@gmail.com.
Abstract
BACKGROUND: Cardiac remodeling and its reversibility are key in HF outcomes. The ST2-R2 score was recently developed to predict relevant left ventricular (LV) reverse remodeling (R2) in patients with heart failure (HF). In the present study we sought to validate the ST2-R2 score for grading improvement in LV ejection fraction (EF) and LV size at one year, and to evaluate its prognostic implication up to 4 years. METHODS: A total of 569 patients with baseline LVEF <40% from three international cohorts (Barcelona, TIME-CHF, and PROTECT) were included in the study. Patients were classified into four strata based on their ST2-R2 score, which took into account concentrations of the biomarker ST2, non-ischemic etiology, absence of left bundle branch block, HF duration, baseline LVEF, and β-blocker treatment. RESULTS: A significant relationship was observed between ST2-R2 scores and changes in LVEF and indexed LV sizes. LVEF recovery (from +5.6% to +17.3%; p<0.001), percentage reduction in LV end-systolic volume index (from -6.1% to -32.1%; p<0.001) and in LV end-systolic diameter index (from -1.1% to -18.6%; p<0.001) increased over the ST2-R2 strata. A similar trend was observed with diastolic parameters. Improvement in LV function and size was inversely predictive of mortality. Hazard ratios for risk of death, using the lower ST2-R2 score strata (<9) as a reference, were 0.49 (p<0.001; score 9-11), 0.27 (p<0.001; score 12-14), and 0.17 (p<0.001; score 15-17). CONCLUSIONS: The ST2-R2 score predicts reverse LV remodeling in HF patients and is useful for predicting mortality up to 4years.
BACKGROUND: Cardiac remodeling and its reversibility are key in HF outcomes. The ST2-R2 score was recently developed to predict relevant left ventricular (LV) reverse remodeling (R2) in patients with heart failure (HF). In the present study we sought to validate the ST2-R2 score for grading improvement in LV ejection fraction (EF) and LV size at one year, and to evaluate its prognostic implication up to 4 years. METHODS: A total of 569 patients with baseline LVEF <40% from three international cohorts (Barcelona, TIME-CHF, and PROTECT) were included in the study. Patients were classified into four strata based on their ST2-R2 score, which took into account concentrations of the biomarker ST2, non-ischemic etiology, absence of left bundle branch block, HF duration, baseline LVEF, and β-blocker treatment. RESULTS: A significant relationship was observed between ST2-R2 scores and changes in LVEF and indexed LV sizes. LVEF recovery (from +5.6% to +17.3%; p<0.001), percentage reduction in LV end-systolic volume index (from -6.1% to -32.1%; p<0.001) and in LV end-systolic diameter index (from -1.1% to -18.6%; p<0.001) increased over the ST2-R2 strata. A similar trend was observed with diastolic parameters. Improvement in LV function and size was inversely predictive of mortality. Hazard ratios for risk of death, using the lower ST2-R2 score strata (<9) as a reference, were 0.49 (p<0.001; score 9-11), 0.27 (p<0.001; score 12-14), and 0.17 (p<0.001; score 15-17). CONCLUSIONS: The ST2-R2 score predicts reverse LV remodeling in HF patients and is useful for predicting mortality up to 4years.
Authors: Jonathan Beaudoin; Jackie Szymonifka; Zachary Lavender; Roderick C Deaño; Qing Zhou; James L Januzzi; Jagmeet P Singh; Quynh A Truong Journal: J Thorac Dis Date: 2019-12 Impact factor: 2.895
Authors: Jasneet K Devgun; Samuel Kennedy; Jeremy Slivnick; Zachary Garrett; Katherine Dodd; Mohamed H Derbala; Cristina Ortiz; Sakima A Smith Journal: ESC Heart Fail Date: 2021-12-24