Published: 2017-06-24

Role of sST2 in prognostication and risk stratification in patients with heart failure

Gaurav Pradip Thakre, Manjunath Bagur Venkat, Bhabani Charan Sahoo


Background: sST2, an interleukin (IL)-1 receptor family member, has been identified as a novel biomarker for cardiac strain. Concentrations of sST2 have prognostic value and found to be predictive of the rate of mortality in the follow-up of patients after an acute heart failure episode. The present study aims to study relationship between serum sST2 levels along with prognosis and risk of mortality in heart failure patients.

Methods: The Study was conducted in A.J. Institute of Medical Sciences, Mangalore, Karnataka, India with 56 heart failure patients in the duration of 1 year. sST2 level of each patient was taken on the day of admission then after one month, six months and one year.

Results: Concentration of sST2 was consistently higher in 55.3% patients. Patients with lower values of ST2 levels were having less number of hospital admissions for heart failure symptoms (44.6%). The patients who were having high ST2 levels died due to cardiac events by the end of one month, six months and one year were 7.1%, 11.5% and 13% respectively (p<0.001) which was highly significant. Overall mortality with the patients who were having higher ST2 levels was 28.5% (p<0.001 HS).

Conclusions: Elevated sST2 levels are predictive of cardiac events in patients with heart failure and provide complementary information about prognostication and risk stratification of patient. Serial monitoring of sST2 will aid in clinical decision making.


CRT-D- Cardiac resynchronization therapy defibrillator, CRT-P- Cardiac resynchronization therapy pacemaker, HF- Heart failure, ICD- Implantable cardioverter defibrillator

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Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics-2010 update. Circulation. 2010;121(7):e46-215.

Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SL, et al. Trends in length of stay and short-term outcomes among medicare patients hospitalized for heart failure, 1993-2006. JAMA. 2010;303(21):2141-7.

Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007;154(2): 260e-6.

Graff L, Orledge J, Radford MJ, Wang Y, Petrillo M, Maag R. Correlation of the Agency for health care policy and research congestive heart failure admission guideline with mortality: peer review organization voluntary hospital association initiative to decrease events (PROVIDE) for congestive heart failure. Ann Emerg Med. 1999;34:429e-37.

Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29e-37.

Iwahana H, Yanagisawa K, Ito‐Kosaka A, Kuroiwa K, Tago K, Komatsu N, et al. Different promoter usage and multiple transcription initiation sites of the interleukin-1 receptor-related human ST2 gene in UT-7 and TM12 cells. Eur J Biochem. 1999;264:397-406.

Weinberg EO, Shimpo M, De Keulenaer GW, MacGillivray C, Tominaga SI, Solomon SD, et al. Expression and regulation of ST2, an interleukin-1 receptor family member, in cardiomyocytes and myocardial infarction. Circulation. 2002;106:2961-6.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. American college of cardiology foundation; American heart association task force on practice guidelines. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. J Am Coll Cardiol. 2013;62:1495e-539.

Tapanainen JM, Lindgren KS, Makikallio TH, Vuolteenaho O, Leppaluoto J, Huikuri HV. Natriuretic peptides as predictors of non-sudden and sudden cardiac death after acute myocardial infarction in the beta-blocking era. J Am Coll Cardiol. 2004;43:757- 63.

Weinberg EO, Shimpo M, Hurwitz S, Tominaga SI, Rouleau JL, Lee RT. Identification of serum soluble ST2 receptor as a novel heart failure biomarker. Circulation. 2003 Feb 11;107(5):721-6.

Bayes‐Genis A, Antonio M, Galan A, Sanz H, Urrutia A, Cabanes R, et al. Combined use of high-sensitivity ST2 and NT-proBNP to improve the prediction of death in heart failure. Eur J Heart Fail. 2012;14(1):32-8.

Ky B, French B, McCloskey K, Rame JE, McIntosh E, Shahi P, et al. High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure. Circ Heart Fail. 2011;4:180-7.

Boisot S, Beede J, Isakson S, Chiu A, Clopton P, Januzzi J, et al. Serial sampling of ST2 predicts 90-day mortality following destabilized heart failure. J Card Fail. 2008;14:732-8.