Head-to-Head Comparison of Serial Soluble ST2, Growth Differentiation Factor-15, and Highly-Sensitive Troponin T Measurements in Patients With Chronic Heart Failure

Study Questions:

What is the role of serial measurement of soluble ST2 (sST2), growth differentiation factor-15 (GDF-15), and highly-sensitive troponin T (hs-TnT) in chronic heart failure (CHF)?


The study authors conducted a post-hoc analysis using data from the PROTECT study (Use of NT-proBNP Testing to Guide Heart Failure Therapy in the Outpatient Setting), in which 151 systolic HF patients were followed up over 10 months. In this study, N-terminal pro–B-type natriuretic peptide (NT-proBNP), sST2, GDF-15, and hs-TnT were measured at each visit, and any major cardiovascular (CV) events were recorded.


The study authors found that baseline values of all three novel biomarkers independently predicted total CV events (p < 0.001). The model’s predictive ability improved with the addition of serial measurements (with sST2 being the most promising biomarker); however, it was unclear whether this addition is a unique contribution. When the study authors included time-dependent factors, only sST2 serial measurement independently added to the risk model (odds ratio [OR], 3.64; 95% confidence interval [CI], 1.37-9.67; p = 0.009) and predicted reverse myocardial remodeling (OR, 1.22; 95% CI, 1.04-1.43; p = 0.01).


The authors concluded that baseline measurement of novel biomarkers added independent prognostic information to clinical variables and NT-proBNP. However, only serial measurement of sST2 appeared to add prognostic information to baseline concentrations and predicted change in left ventricular function.


As more and more biomarkers are available, it is increasingly apparent that a panel of biomarkers may add incremental value in the management of HF. For example, when both BNP and troponin are elevated in HF, the mortality risk increases 12-fold when compared to patients with undetectable troponin and lower levels of BNP (Circulation 2003;108:833-8). Similarly, the findings of this study suggest that incorporating novel biomarkers sST2, GDF-15, and hs-TnT appears to add prognostic information. Large multicenter trials are now required to validate the utility of these novel biomarkers and possibly combine them with tissue Doppler (JACC Cardiovasc Imaging 2009;2:216-25) to provide more value.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Prognosis, Biological Markers, Growth Differentiation Factor 15, Heart Failure, Troponin, Natriuretic Peptide, Brain

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