Soluble ST2: An Emerging Cardiac Biomarker for Heart Failure Prognosis
This review describes soluble ST2 (sST2) as a biomarker reflecting maladaptive myocardial fibrosis and remodelling through sequestration of the cardioprotective IL-33/ST2L signalling pathway. Circulating sST2 concentrations independently predict death in both acute and chronic heart failure regardless of ejection fraction, add prognostic information beyond natriuretic peptides and troponins, and show promise for stratifying sudden cardiac death risk in patients with depressed left ventricular function.
The original study
Clinical relevance of sST2 in cardiac diseases.
- Authors
- Pascual-Figal DA, Lax A, Perez-Martinez MT, del Carmen Asensio-Lopez M, Sanchez-Mas J
- Journal
- Clinical chemistry and laboratory medicine
- Type
- Journal Article, Research Support, Non-U.S. Gov't, Review
- PMID
- 26544104
Original abstract
ST2 has two main isoforms, ST2L and soluble isoform of ST2 (sST2), by alternative splicing. The interaction between interleukin (IL)-33 and the transmembrane isoform ST2L is up-regulated in response to myocardial stress and exerts cardio-protective actions in the myocardium by reducing fibrosis, hypertrophy and enhancing survival. The circulating isoform sST2, by sequestering IL-33, abrogates these favorable actions and will be elevated as a maladaptive response to cardiac diseases. Indeed, circulating sST2 concentrations correlate with a worse phenotype of disease including adverse remodeling and fibrosis, cardiac dysfunction, impaired hemodynamics and higher risk of progression. In patients with acute and chronic heart failure, sST2 concentrations are strongly predictive of death, regardless of the cause and left ventricle (LV) ejection fraction, and contribute relevant information in addition to other prognosticators and biomarkers, as natriuretic peptides or troponins. sST2 also retains prognostic information in the setting of acute myocardial infarction (AMI) and predicts cardiovascular death and risk of heart failure (HF) development in these patients. sST2 could also be a promising tool to stratify the risk of sudden cardiac death (SCD) in patients with depressed LV ejection fraction. Therefore, sST2 represents a clinically relevant biomarker reflecting pathophysiological processes and contributing predictive information in the setting of several cardiovascular diseases, and especially in patients with HF.