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Circulating levels and prognostic cut-offs of sST2, hs-cTnT, and NT-proBNP in women vs. men with chronic heart failure

Research output: Contribution to journalJournal articleResearchpeer-review


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  • Giuseppe Vergaro
  • Francesco Gentile
  • Alberto Aimo
  • James L Januzzi
  • A Mark Richards
  • Carolyn S P Lam
  • Rudolf A de Boer
  • 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
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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.

Original languageEnglish
JournalESC Heart Failure
Issue number4
Pages (from-to)2084-2095
Number of pages12
Publication statusPublished - Aug 2022

Bibliographical note

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

    Research areas

  • Aged, Biomarkers, Chronic Disease, Female, Heart Failure/diagnosis, Humans, Interleukin-1 Receptor-Like 1 Protein/blood, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Prognosis, Stroke Volume, Troponin T, Ventricular Function, Left

ID: 77930188