Cardiac Biomarkers in the Emergency Department: The Role of Soluble ST2 (sST2) in Acute Heart Failure and Acute Coronary Syndrome-There is Meat on the Bone.

Aneta Aleksova,Michele Emdin,Laura Padoan,Antonio Beltrami,Alan Maisel,Gianfranco Sinagra,Alessia Paldino,Massimo Iacoviello

doi:10.3390/jcm8020270

Abstract

Soluble ST2 (sST2) has recently emerged as a promising biomarker in the field of acute cardiovascular diseases. Several clinical studies have demonstrated a significant link between sST2 values and patients’ outcome. Further, it has been found that higher levels of sST2 are associated with an increased risk of adverse left ventricular remodeling. Therefore, sST2 could represent a useful tool that could help the risk stratification and diagnostic and therapeutic work-up of patients admitted to an emergency department. With this review, based on recent literature, we have built sST2-assisted flowcharts applicable to three very common clinical scenarios of the emergency department: Acute heart failure, type 1, and type 2 acute myocardial infarction. In particular, we combined sST2 levels together with clinical and instrumental evaluation in order to offer a practical tool for emergency medicine physicians.

Highlights

ST2 is a member of the superfamily of interleukin (IL)-1 receptors that exists in two forms: A transmembrane receptor (ST2L) and a soluble one, expressed through an alternative splicing [1]
Thereafter, the role of Soluble ST2 (sST2) in ruling out acutely decompensated heart failure (ADHF) in Emergency Department (ED) has been confirmed by Henry-Okafor and colleagues [26]. They reported an area under the curve (AUC) for sST2 that was similar to the PRIDE AUC: 0.62 vs. 0.74, respectively, but both were inferior to those reported for natriuretic peptides (NPs), J
SST2, represents, especially when combined with NPs, troponins, and clinical variables, a promising tool that could improve the risk stratification and diagnostic–therapeutic work-up of patients admitted to the ED

Summary

Introduction

ST2 is a member of the superfamily of interleukin (IL)-1 receptors that exists in two forms: A transmembrane receptor (ST2L) and a soluble one (sST2, denoted as ST2), expressed through an alternative splicing [1]. In contrast to NPs, sST2 is not influenced by either age, body mass index, renal function, or etiology of HF [21,22] and, compared to the other biomarkers, it has the lowest intra-individual variation and the smallest relative change value [23,24] For these properties, it has been tested as a potential biomarker for the differential diagnosis of ADHF [17,25]. In patients with dyspnea and elevated NPs, a sST2 flowchart (Figure 1) could be useful for a more accurate diagnosis, risk stratification, and appropriate treatment of ADHF in the ED, as it has been proposed for chronic heart failure [10]. If improvement of dyspnea is observed after diuretic therapy, clinical reassessment and instrumental evaluation in ED should be performed, in order to decide if the patient needs hospitalization or could be managed on an outpatient basis

ST2 in Acute Myocardial Infarction

Findings

Conclusions