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

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 beta-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. (C) 2015 Elsevier Ireland Ltd. All rights reserved.