Soluble ST2 – a new biomarker in heart failure

Abstract

Cardiovascular biomarkers play an essential role in the diagnosis, risk stratification and treatment of patients with cardiac diseases and in particular heart failure patients. However, the accuracy of most biomarkers is limited by confounding comorbidities, rendering their interpretation difficult. The relatively new biomarker sST2 (soluble suppression of tumourigenicity 2) is said to reflect myocardial wall stress and activation of the fibrosis pathway and to be less dependent on common confounders. Elevated sST2 levels in acute heart failure patients predict both rehospitalisation and mortality. Chronic heart failure patients who have sST2 levels responsive to medical treatment have a better outcome. However, elevated sST2 levels in the absence of heart failure or heart disease are not uncommon and limit its use for diagnostic purposes in a general non-heart failure population. This review reflects the presentations and discussion by the participants at the first meeting of the Swiss working group on cardiovascular biomarkers held in September 2018 in Zurich, Switzerland. It also highlights current Swiss experience with sST2 and indicates areas of uncertainty, in particular the need to identify the exact pathway of sST2 in cardiac disease and specify its clinical implications for subgroups of heart failure and non-heart failure patients.