Prognostic Value of Serial Measurements of sST 2 and Galectin-3 in Ambulatory Chronic Heart Failure Patients

Background: B-type natriuretic peptides (BNP) and troponin T (cTnT) predict cardiovascular events in heart failure (HF) patients, but additional refinement in risk stratification may be possible by targeting pathways leading to fibrosis. We aimed to assess the value of serial measurements of sST2 ( soluble ST2) and galectin-3 to identify risk for adverse pathophysiological processes. Methods: Class III-IV HF patients (N=180; LVEF ≤40%)) were prospectively evaluated with biomarkers collected every 3 months over 2 years and analyzed in relation to primary end-point of death/cardiac transplantation and the secondary end-point of heart failure-related hospitalization or death/transplantation. Results: Time-dependent univariate analyses demonstrated that elevations of sST2 ( ≥49.3ng/mL male, ≥33.5ng/mL female) and galectin-3 ( ≥22.1ng/mL) were predictive of the primary and secondary endpoints. In multivariate models adjusted for BNP, cTnT, and clinical variables, sST2 but not galectin-3 remained an independent predictor (HR 3.22, 1.76-5.89, p<0.001). With serial measurements only sST2 demonstrated incremental value in reclassifying patients to higher risk. Conclusions: Serial monitoring of sST2 (indicative of myocardial fibrosis and remodeling) and cTnT (reflecting myocardial injury) identifies highest-risk HF outpatients and may be valuable to guide patient tailored therapy during follow up evaluations. Serial galectin-3 monitoring in ambulatory HF patients may not be of benefit.