Prediction of survival and magnitude of reverse remodeling using the ST2-R2 score in heart failure: A multicenter study

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• 作者：Josep Lupó ; n^a ; ^b ; ¹ ; Sandra Sanders-van Wijk^c ; ¹ ; James L. Januzzi^d ; ¹ ; Marta de Antonio^a ; ¹ ; Hanna K. Gaggin^d ; ¹ ; Matthias Pfisterer^e ; ¹ ; Amparo Galá ; n^f ; ¹ ; Ravi Shah^d ; ¹ ; Hans-Peter Brunner-La Rocca^c ; ¹ ; Antoni Bayes-Genis^a ; ^b ; ¹ ; ^{abayesgenis@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HF ; Heart failure ; HFrEF ; Heart failure with reduced ejection fraction ; LBBB ; Left bundle branch block ; LV ; Left ventricular ; LVEF ; Left ventricular ejection fraction ; LVEDDi ; Left ventricular end-diastolic diameter index ; LVESDi ; Left ventricular end-systolic diameter index ; LVEDVi ; Left ventricular end-diastolic volume index ; LVESVi ; Left ventricular end-systolic volume index ; R2 ; Reverse remodeling ; ST2 ; Soluble ST2
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 February 2016
• 年：2016
• 卷：204
• 期：Complete
• 页码：242-247
• 全文大小：452 K

文摘

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 4 years.