BACKGROUND Several clinical studies have evaluated the association between ST2 and outcome in patients with heart failure (HF). However, little is known about the predictive value of frequently measured ST2 levels in patients with acute HF. OBJECTIVES This study sought to describe the prognostic value of baseline and repeated ST2 measurements in patients with acute HF. METHODS In the TRIUMPH (Translational Initiative on Unique and novel strategies for Management of Patients with Heart failure) clinical cohort study, 496 patients with acute HF were enrolled in 14 hospitals in the Netherlands between 2009 and 2014. Repeated blood samples (7) were drawn during 1-year follow-up. ST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured in a central laboratory. The primary endpoint was the composite of all-cause mortality and HF rehospitalization. Associations between repeated biomarker measurements and the primary endpoint were assessed using a joint model. RESULTS Median age was 74 years, and 37% of patients were women. The primary endpoint was reached in 188 patients (40%) during a median follow-up of 325 days (interquartile range: 85 to 401). The median baseline ST2 level was 71 ng/ml (interquartile range: 46 to 102). After adjustment for clinical factors and NT-proBNP, baseline ST2 was associated with an increased risk of the primary endpoint, and the hazard ratio per 1 SD increase of the baseline ST2 level (on the log2 scale) was 1.30 (95% confidence interval: 1.08 to 1.56; p = 0.005). When repeated measurements were taken into account, the adjusted hazard ratio per 1 SD increase of the ST2 level (on the log2 scale) during follow-up increased to 1.85 (95% confidence interval: 1.02 to 3.33; p = 0.044), adjusted for clinical factors and repeated measurements of NT-proBNP. Furthermore, ST2 levels appeared to elevate several weeks before the time of the primary endpoint. CONCLUSIONS Repeated ST2 measurements appeared to be a strong predictor of outcome in patients with acute HF, independent of repeatedly measured NT-proBNP. Hence ST2 may be helpful in clinical practice for prognostication and treatment monitoring. (TRanslational Initiative on Unique and novel strategies for Management of Patients with Heart failure [TRIUMPH]; NTR1893).

中文翻译：

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急性心力衰竭患者连续测量 ST2 的预后价值

背景 几项临床研究已经评估了 ST2 与心力衰竭 (HF) 患者结果之间的关联。然而，关于频繁测量的 ST2 水平对急性 HF 患者的预测价值知之甚少。目的 本研究旨在描述基线和重复 ST2 测量对急性 HF 患者的预后价值。方法 在 TRIUMPH（心力衰竭患者管理独特和新颖策略的转化计划）临床队列研究中，2009 年至 2014 年间，荷兰 14 家医院招募了 496 名急性 HF 患者。重复抽取血样 (7)在 1 年的随访期间。ST2 和 N 端前 B 型利钠肽 (NT-proBNP) 水平在中心实验室进行测量。主要终点是全因死亡率和心衰再住院的复合终点。使用联合模型评估重复生物标志物测量与主要终点之间的关联。结果 中位年龄为 74 岁，37% 的患者为女性。在中位随访 325 天（四分位距：85 至 401）期间，188 名患者（40%）达到了主要终点。中位基线 ST2 水平为 71 ng/ml（四分位距：46 至 102）。调整临床因素和 NT-proBNP 后，基线 ST2 与主要终点风险增加相关，基线 ST2 水平（log2 量表）每增加 1 个 SD 的风险比为 1.30（95% 置信区间： 1.08 到 1.56；p = 0.005)。当考虑到重复测量时，随访期间 ST2 水平每增加 1 个 SD 的调整后风险比（在 log2 量表上）增加至 1.85（95% 置信区间：1.02 至 3.33；p = 0.044），根据临床因素和重复测量 NT- BNP原。此外，ST2 水平似乎在主要终点时间前几周升高。结论 重复 ST2 测量似乎是急性 HF 患者预后的强预测因子，独立于重复测量的 NT-proBNP。因此，ST2 可能有助于临床实践中的预后和治疗监测。（心力衰竭患者管理独特和新颖策略的翻译倡议 [TRIUMPH]；NTR1893）。调整临床因素和重复测量 NT-proBNP。此外，ST2 水平似乎在主要终点时间前几周升高。结论 重复 ST2 测量似乎是急性 HF 患者预后的强预测因子，独立于重复测量的 NT-proBNP。因此，ST2 可能有助于临床实践中的预后和治疗监测。（关于心力衰竭患者管理的独特和新颖策略的翻译倡议 [TRIUMPH]；NTR1893）。调整临床因素和重复测量 NT-proBNP。此外，ST2 水平似乎在主要终点时间前几周升高。结论 重复 ST2 测量似乎是急性 HF 患者预后的强预测因子，独立于重复测量的 NT-proBNP。因此，ST2 可能有助于临床实践中的预后和治疗监测。（关于心力衰竭患者管理的独特和新颖策略的翻译倡议 [TRIUMPH]；NTR1893）。因此，ST2 可能有助于临床实践中的预后和治疗监测。（关于心力衰竭患者管理的独特和新颖策略的翻译倡议 [TRIUMPH]；NTR1893）。因此，ST2 可能有助于临床实践中的预后和治疗监测。（关于心力衰竭患者管理的独特和新颖策略的翻译倡议 [TRIUMPH]；NTR1893）。