Elevated Plasma Soluble St2 Is Associated With Heart Failure Symptoms And Outcome In Aortic Stenosis

B-type natriuretic peptide (BNP) is often used as a complementary finding in the diagnostic work-up of patients with aortic stenosis (AS). Whether soluble ST2, a new biomarker of cardiac stretch, is associated with symptomatic status and outcome in asymptomatic AS is unknown. sST2 and BNP levels were measured in 86 patients (74 +/- 13 years; 59 asymptomatic, 69%) with AS (< 1.5 cm(2)) and preserved left ventricular ejection fraction who were followed-up for 26 +/- 16 months. Both BNP and sST2 were associated with NYHA class but sST2 (> 23 ng/mL, AUC = 0.68, p< 0.01) was more accurate to identify asymptomatic patients or those who developed symptoms during follow-up. sST2 was independently related to left atrial index (p< 0.0001) and aortic valve area (p = 0.004; model R-2 = 0.32). A modest correlation was found with BNP (r = 0.4, p< 0.01). During follow-up, 29 asymptomatic patients (34%) developed heart failure symptoms. With multivariable analysis, peak aortic jet velocity (HR = 2.7, p = 0.007) and sST2 level (HR = 1.04, p = 0.03) were independent predictors of cardiovascular events. In AS, sST2 levels could provide complementary information regarding symptomatic status, new onset heart failure symptoms and outcome. It might become a promising biomarker in these patients.