ST2 clinical role in heart failure

Justas Krištopaitis1, Judita Petro1, Jolanta Laukaitienė1

1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


Heart failure (HF) is a major cause of morbidity and mortality in the Western World. Improvements in patient management are needed because most patients with HF die despite evidence-based treatment. Although many new candidate biomarkers have been evaluated to help fill this gap, suppression of tumorigenesis-2 (ST2) is the most promising one. The purpose of this study is to present a systematic review of the available evidence-based literature concerning ST2 clinical importance and role in HF.

ST2 is a member of the interleukin 1 receptor family and have two forms: a soluble decoy receptor (sST2) and a trans – membrane receptor (ST2L). Interleukin-33 is a functional ligand of ST2, which is involved in reducing fibrosis and hypertrophy in mechanically strained tissue. Recent studies have demonstrated soluble ST2 to be a strong independent predictor of cardiovascular outcomes in both chronic and acute HF.  ST2 has also been found to be independent predictor of need for transplantation and adverse outcomes in patients with ST2 elevation myocardial infarction. ST2 can be used to predict left ventricular reverse remodeling in systolic heart failure and after myocardial infarction. ST2 can help to optimize beta-blockers (BB) dose or identify patients who will benefit the most during patient management of chronic HF. Compared to other cardiac biomarkers, ST2 adds information to natriuretic peptides (NPs), and some studies shown it is even superior in terms of risk stratification. Compared to NPs, ST2 levels do not correlate with patient age, gender, body mass index (BMI) or renal function. However, most studies agree that repeated measurement of ST2 are needed to improve its prognostic value in HF.

It is hoped that this review will help clinicians to optimize individual treatment, prognose survivability and adverse outcomes in patients with HF during hospitalization or ambulatory care.  Based on current literature, ST2 is ready for clinical use.

Keywords: biomarker, heart failure, prognosis, monitoring, ST2, myocardial infarction, remodeling.