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

Josep Lupón, Hanna K. Gaggin, Marta De Antonio, Mar Domingo, Amparo Galán, Elisabet Zamora, Joan Vila, Judith Peñafiel, Agustín Urrutia, Elena Ferrer, Nuria Vallejo, James L. Januzzi, Antoni Bayes-Genis

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60 Citations (Scopus)


© 2015 Elsevier Ireland Ltd. All rights reserved. Background: Limited data exists regarding biomarker use to predict left ventricular (LV) reverse remodeling (R2). Our aimwas 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 b40%. 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 b 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 b 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 b48 ng/mL, non-ischemic etiology, absence of LBBB, HF duration b12 months, baseline LVEF b24%, and β-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.
Original languageEnglish
Pages (from-to)337-343
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - 1 Jan 2015


  • Biomarkers
  • Heart failure
  • LVEF
  • Reverse remodeling
  • ST2


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