ESC Heart Failure (Aug 2022)
Circulating levels and prognostic cut‐offs of sST2, hs‐cTnT, and NT‐proBNP in women vs. men with chronic heart failure
- Giuseppe Vergaro,
- Francesco Gentile,
- Alberto Aimo,
- James L. Januzzi Jr,
- A. Mark Richards,
- Carolyn S.P. Lam,
- Rudolf A. deBoer,
- Laura M.G. Meems,
- Roberto Latini,
- Lidia Staszewsky,
- Inder S. Anand,
- Jay N. Cohn,
- Thor Ueland,
- Lars Gullestad,
- Pål Aukrust,
- Hans‐Peter Brunner‐La Rocca,
- Antoni Bayes‐Genis,
- Josep Lupón,
- Akiomi Yoshihisa,
- Yasuchika Takeishi,
- Michael Egstrup,
- Ida Gustafsson,
- Hanna K. Gaggin,
- Kai M. Eggers,
- Kurt Huber,
- Greg D. Gamble,
- Lieng H. Ling,
- Kui Toh Gerard Leong,
- Poh Shuah Daniel Yeo,
- Hean Yee Ong,
- Fazlur Jaufeerally,
- Tze P. Ng,
- Richard Troughton,
- Robert N. Doughty,
- Gerry Devlin,
- Mayanna Lund,
- Alberto Giannoni,
- Claudio Passino,
- Michele Emdin
Affiliations
- Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio via Giuseppe Moruzzi 1 Pisa 56124 Italy
- Francesco Gentile
- Cardiology Division Pisa University Hospital Pisa Italy
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio via Giuseppe Moruzzi 1 Pisa 56124 Italy
- James L. Januzzi Jr
- Massachusetts General Hospital and Baim Institute for Clinical Research Boston MA USA
- A. Mark Richards
- Department of Medicine University of Otago, New Zealand & National University Heart Centre, National University of Singapore Singapore
- Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of Singapore Singapore
- Rudolf A. deBoer
- University Medical Centre Groningen Groningen The Netherlands
- Laura M.G. Meems
- University Medical Centre Groningen Groningen The Netherlands
- Roberto Latini
- Istituto di Ricerche Farmacologiche – “Mario Negri” (IRCCS) Milan Italy
- Lidia Staszewsky
- Istituto di Ricerche Farmacologiche – “Mario Negri” (IRCCS) Milan Italy
- Inder S. Anand
- University of Minnesota Medical Center University of Minnesota Minneapolis MN USA
- Jay N. Cohn
- University of Minnesota Medical Center University of Minnesota Minneapolis MN USA
- Thor Ueland
- Oslo University Hospital, Ullevål Oslo Norway
- Lars Gullestad
- KG Jebsen Center for Cardiac Research, University of Oslo and Center for Heart Failure Research Oslo University Hospital Norway
- Pål Aukrust
- Oslo University Hospital, Rikshospitalet Oslo Norway
- Hans‐Peter Brunner‐La Rocca
- Maastricht University Medical Centre Maastricht The Netherlands
- Antoni Bayes‐Genis
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
- Josep Lupón
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
- Akiomi Yoshihisa
- First Department of Internal Medicine Fukushima Medical University Fukushima Japan
- Yasuchika Takeishi
- First Department of Internal Medicine Fukushima Medical University Fukushima Japan
- Michael Egstrup
- Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Ida Gustafsson
- Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Hanna K. Gaggin
- Heart Center Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Kai M. Eggers
- Department of Medical Sciences Uppsala University Uppsala Sweden
- Kurt Huber
- Wilhelminenspital and Sigmund Freud University Medical School Vienna Austria
- Greg D. Gamble
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Lieng H. Ling
- Department of Cardiology National University Heart Centre and National University of Singapore Singapore
- Kui Toh Gerard Leong
- Changi General Hospital Singapore
- Poh Shuah Daniel Yeo
- Tan Tock Seng Hospital Singapore
- Hean Yee Ong
- Khoo Teck Puat Hospital Singapore
- Fazlur Jaufeerally
- Singapore General Hospital Singapore
- Tze P. Ng
- Department of Cardiology National University Heart Centre and National University of Singapore Singapore
- Richard Troughton
- Department of Medicine University of Otago, New Zealand & National University Heart Centre, National University of Singapore Singapore
- Robert N. Doughty
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
- Gerry Devlin
- Gisborne Hospital Gisborne New Zealand
- Mayanna Lund
- Middlemore Hospital Auckland New Zealand
- Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio via Giuseppe Moruzzi 1 Pisa 56124 Italy
- Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio via Giuseppe Moruzzi 1 Pisa 56124 Italy
- Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio via Giuseppe Moruzzi 1 Pisa 56124 Italy
- DOI
- https://doi.org/10.1002/ehf2.13883
- Journal volume & issue
-
Vol. 9,
no. 4
pp. 2084 – 2095
Abstract
Abstract Aims To define plasma concentrations, determinants, and optimal prognostic cut‐offs of soluble suppression of tumorigenesis‐2 (sST2), high‐sensitivity cardiac troponin T (hs‐cTnT), and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in women and men with chronic heart failure (HF). Methods and results Individual data of patients from the Biomarkers In Heart Failure Outpatient Study (BIOS) Consortium with sST2, hs‐cTnT, and NT‐proBNP measured were analysed. The primary endpoint was a composite of 1 year cardiovascular death and HF hospitalization. The secondary endpoints were 5 year cardiovascular and all‐cause death. The cohort included 4540 patients (age 67 ± 12 years, left ventricular ejection fraction 33 ± 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/mL, P < 0.001) and hs‐cTnT level (15 vs. 20 ng/L, P < 0.001), and similar concentrations of NT‐proBNP (1540 vs. 1505 ng/L, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut‐off was lower in women for sST2 (28 vs. 31 ng/mL) and hs‐cTnT (22 vs. 25 ng/L), while NT‐proBNP cut‐off was higher in women (2339 ng/L vs. 2145 ng/L). The use of sex‐specific cut‐offs improved risk prediction compared with the use of previously standardized prognostic cut‐offs and allowed to reclassify the risk of many patients, to a greater extent in women than men, and for hs‐cTnT than sST2 or NT‐proBNP. Specifically, up to 18% men and up to 57% women were reclassified, by using the sex‐specific cut‐off of hs‐cTnT for the endpoint of 5 year cardiovascular death. Conclusions In patients with chronic HF, concentrations of sST2 and hs‐cTnT, but not of NT‐proBNP, are lower in women. Lower sST2 and hs‐cTnT and higher NT‐proBNP cut‐offs for risk stratification could be used in women.
Keywords