Novel biomarker for heart failure also predicts risk of death

An international research team, led by James Januzzi Jr., MD, of the MGH Cardiology Division, has found that blood levels of a protein called ST2 both indicate the presence of heart failure among patients with shortness of breath and powerfully predict the risk that a patient will die during the following year. Improved understanding of how ST2 and other biomarkers reflect the heart’s hormonal environment someday may allow clinicians to develop more effective, individualized treatment plans.

“While we are now able to diagnose heart failure with great sensitivity, we have miles to go before we can reduce the considerable risk that accompanies that diagnosis,” says Januzzi. “It’s highly likely that examining a patient’s pattern of several complementary biomarkers will be superior for predicting risk than using just one. If we could harness the information these biomarkers yield to better adjust therapies – in the same way that antibiotics are chosen based on the organism causing the infection – it would be revolutionary.”

In 2005, Januzzi and MGH colleagues published the PRIDE study, which showed that a protein called NT-proBNP could confirm or rule out heart failure in emergency room patients with shortness of breath and also help predict death among such patients. Recent smaller studies have suggested that ST2, which also may have a role in the inflammatory response, is expressed within the heart in situations involving stress to the cardiac muscle, including heart failure. To more closely examine ST2’s potential as a heart failure biomarker, the research team analyzed data and blood samples from the approximately 600 PRIDE study participants who had come to the MGH Emergency Department with shortness of breath. The results confirmed ST2 as a marker of heart failure and indicated the protein was an even stronger predictor of death from several causes than was NT-proBNP. A combination of both biomarkers gave the most accurate prediction.

The study will appear in the Journal of the American College of Cardiology and has received early online release. Other MGH co-authors are Claudia Chae, MD, MPH; Aaron Baggish, MD; Michelle O’Donoghue, MD; Rahul Sakhuja, MD; Annabel Chen, MD; and Kent Lewandrowski, MD, all of MGH Cardiology.