Biomarker-assist score for reverse remodeling prediction in heart failure: The ST2-R2 score

Background: Limited data exists regarding biomarker use to predict left ventricular (LV) reverse remodeling (R2). Our aim was to examine the value of soluble ST2 (ST2), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and galectin-3 relative to LV-R2 in systolic heart failure (HF), and to develop a clinical score for LV-R2 prediction. Methods: R2 was defined as a) LV ejection fraction (LVEF) increase >= 15%, or b) LVEF increase >= 10% plus reduction of LV end-systolic diameter index >= 20% or LV end-systolic volume >= 40%, for 12 months. Results: We studied 304 patients (79.6% men, mean age 66.1 +/- 12.3 years) with baseline LVEF <40%. R2 was observed in 104 patients (34.2%). In univariable logistic regression, factors associatedwith R2 were age (p = 0.02), non-ischemic etiology of HF (p < 0.001), NYHA functional class (p = 0.02), baseline LVEF (p = 0.005), absence of left bundle branch block (LBBB; p = 0.002), ST2 (p = 0.004), NT-proBNP (p = 0.005), and hs-cTnT (p < 0.001); HF duration achieved borderline significance (p = 0.08). In multivariable analysis, ST2 remained the only biomarker associated with LV-R2. We developed the ST2-R2 score for use in clinical practice for predicting R2; variables included were ST2 <48 ng/mL, non-ischemic etiology, absence of LBBB, HF duration <12 months, baseline LVEF <24%, and beta-blocker treatment. The score had an area under the curve of 0.79 in the derivation cohort and 0.73 in a separate validation cohort. Conclusions: The ST2-R2 score, which includes the novel biomarker ST2 and five clinical variables, reasonably predicts LV-R2 in systolic HF patients. ST2 was the only studied biomarker that was independently associated with R2. (C) 2015 Elsevier Ireland Ltd. All rights reserved.