Abstract 12067: Prospective Utility of ST2 in Patients Hospitalized With Acute Decompensated Heart Failure

Abstract

Introduction: The soluble ST2 (sST2) biomarker is upregulated in response to myocardial strain, remodeling and fibrosis, and may play a role in risk stratification of patients with decompensated Heart Failure with a Reduced Ejection Fraction (HFrEF). The widely accepted prognostic sST2 cut-off for chronic HF is 35ng/ml. What this value would be for acute HF is debated. Objectives: To determine the prognostic value of sST2 in patients admitted with acute decompensated HFrEF. Methods: Between January 2020 and June 2021, consecutive patients hospitalized with HFrEF had sST2 measured at admission (within 24 hours) and at recompensation, as part of the INST2ANT-HF study (UK REC no:19/EE/0269). To determine an appropriate prognostic cut-off, we evaluated the median sST2 in our group as a potential threshold. The primary outcome was mortality at one year. Cumulative incidences, and the relationship between several clinical variables were tested in a Cox multivariate model for the primary outcome and comparisons between groups for events was performed using the χ2 test. Results: In the first 34 consecutive patients (Male 64%, AF 38%) with complete follow up (FU) data, median (IQR) FU was 405 (262-438)days. Median (IQR) age, 77 (60-85)years, mean (SD) EF, 27.9(±12.1). Median (IQR) eGFR, 62 (50-83)ml/min/1.73m 2 . Median (IQR) admission sST2 was 68 (43-91)ng/ml and admission NTproBNP was 7307 (5019-12809)ng/L. The primary endpoint occurred more frequently in patients with admission sST2>68ng/ml (p<0.01) (Fig.1). Conclusion: Our data suggests that in an unselected population of patients admitted with acute decompensated HFrEF, an admission sST2 value >68ng/ml has important prognostic value. Patients with high sST2 values on presentation require close follow up and a lower threshold for consideration of advanced HF therapies. A higher sST2 prognostic cut-off compared to CHF patients may hence be required for risk stratification.