Background: Soluble ST2 (sST2) is a novel biomarker reflecting myocardial stress and fibrosis.
Mineralocorticoid receptor antagonist (MRA) has a potential to improve clinical outcomes
in heart failure with preserved ejection fraction (HFpEF), since MRA inhibits progression
of myocardial hypertrophy and fibrosis. Aim: To investigate the relationship between sST2 and outcome, and interaction between
the effect of MRA and the sST2 level in HFpEF. Methods: 191 patients with acute decompensated HF and EF >50% were prospectively enrolled.
The endpoint was major adverse cardiovascular event. Results: During follow-up (421 ± 258 days), 53 patients (27.7%) met endpoints. In multivariable
analysis, the use of MRA and sST2 were significantly associated with the endpoint
(HR 0.48, 95%CI 0.26–0.86, P = .01, HR 1.02, 1.01–1.03, P = .01). Patients were divided into 4 groups according to use of MRA and a cutoff
value of sST2 determined by ROC analysis. In multivariable analysis, MRA was not associated
with outcome in high sST2 group(HR0.62, 0.28–1.30, P = .21), whereas MRA was significantly associated with improved outcome in low sST2
group (HR0.37, 0.13–0.91, P = .03). Conclusion: In HFpEF patients, higher ST-2 level was significantly associated with poor prognosis.
The present study indicated that effect of MRA might be different depending on the
levels of sST2 in HFpEF.
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