AUTHOR=Nicol Martin , Vergaro Giuseppe , Damy Thibaud , Kharoubi Mounira , Baudet Mathilde , Canuti Elena Sofia , Aimo Alberto , Castiglione Vincenzo , Emdin Michele , Royer Bruno , Harel Stephanie , Cohen-Solal Alain , Arnulf Bertrand , Logeart Damien 

TITLE=Prognostic value of soluble ST2 in AL and TTR cardiac amyloidosis: a multicenter study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1179968

DOI=10.3389/fcvm.2023.1179968

ISSN=2297-055X

ABSTRACT=Background: Accurate prognosis stratification in amyloid light-chain (AL) and transthyretin (ATTR) cardiac amyloidosis (CA), both is useful to plan the therapeutic strategies and followup. Cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP) and highsensitivity cardiac troponins (Hs Tn) are the cornerstone of prognosis assessment. Increased soluble suppression of tumorigenesis-2 (sST2) levels is predictive of adverse events (all cause death and heart failure hospitalizations) in heart failure (HF). The study goal was to assess the prognostic value of sST2 circulating levels in AL-and ATTR-CA. Methods: We carried out a multicenter study including 133 patients with AL-CA and 152 with ATTR-CA. During an elective outpatient visit at the diagnosis of CA, Mayo Clinic staging (NTproBNP, Hs TnT, differential of free light chains: DFLC) and sST2 was assessed in all AL patients. Gillmore staging (including estimated glomerular filtration rate (eGFR), NTproBNP) and Grogan staging (including NTproBNP and Hs TnT) were assessed in TTR CA patients. Results: The median age was 73 years (IQR 61-81) and 53% were men. The endpoint was the composite of all-cause death or first HF-related hospitalization. The median follow-up was 20 months (interquartile range [IQR] 3-34) in AL amyloidosis and 33 (6-45) in TTR amyloidosis.The primary outcome occurred in 70 (53%) and 99 (65%) in AL versus TTR patients, respectively. sST2 levels were higher in patients with AL-than ATTR-CA: 39 ng/L (26-80) vs 32 ng/L (21-46), p<0.001. In AL CA, sST2 levels predicted outcome besides the Mayo Clinic score (HR 2.16, 95% CI 1.17-3.99, p< 0.001). In TTR CA, sST2 was not predictive of outcome in multivariate model including Gillmore staging and Grogan staging (HR 1.17, CI 95% 0.77-1.89, p = 0.55).Conclusion: sST2 levels are relevant predictors of deaths and HF hospitalization in AL cardiac amyloidosis and add prognostic stratification on top of NTproBNP, Hs TnT and DFLC.