Soluble ST2 in Ambulatory Patients with Heart Failure Association with Functional Capacity and Long-Term Outcomes

G. Michael Felker, Mona Fiuzat, Vivian Thompson, Linda K. Shaw, Megan L. Neely, Kirkwood F. Adams, David J. Whellan, Mark P. Donahue, Tariq Ahmad, Dalane W. Kitzman, Ileana L. Pin a, Faiez Zannad, William E. Kraus, Christopher M. O Connor

Research output: Contribution to journalArticlepeer-review

117 Scopus citations


BackgroundST2 is involved in cardioprotective signaling in the myocardium and has been identified as a potentially promising biomarker in heart failure (HF). We evaluated ST2 levels and their association with functional capacity and long-term clinical outcomes in a cohort of ambulatory patients with HF enrolled in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) studya multicenter, randomized study of exercise training in HF. Methods and ResultsHF-ACTION randomized 2331 patients with left ventricular ejection fraction <0.35 and New York Heart Association class II to IV HF to either exercise training or usual care. ST2 was analyzed in a subset of 910 patients with evaluable plasma samples. Correlations and Cox models were used to assess the relationship among ST2, functional capacity, and long-term outcomes. The median baseline ST2 level was 23.7 ng/mL (interquartile range, 18.6 31.8). ST2 was modestly associated with measures of functional capacity. In univariable analysis, ST2 was significantly associated with death or hospitalization (hazard ratio, 1.48; P<0.0001), cardiovascular death or HF hospitalization (hazard ratio, 2.14; P<0.0001), and all-cause mortality (hazard ratio, 2.33; P<0.0001; all hazard ratios for log2 ng/mL). In multivariable models, ST2 remained independently associated with outcomes after adjustment for clinical variables and amino-terminal pro-B-type natriuretic peptide. However, ST2 did not add significantly to reclassification of risk as assessed by changes in the C statistic, net reclassification improvement, and integrated discrimination improvement. ConclusionsST2 was modestly associated with functional capacity and was significantly associated with outcomes in a well-treated cohort of ambulatory patients with HF although it did not significantly affect reclassification of risk.

Original languageEnglish (US)
Pages (from-to)1172-1179
Number of pages8
JournalCirculation: Heart Failure
Issue number6
StatePublished - Nov 2013
Externally publishedYes


  • Biomarkers
  • Heart failure
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Soluble ST2 in Ambulatory Patients with Heart Failure Association with Functional Capacity and Long-Term Outcomes'. Together they form a unique fingerprint.

Cite this