Soluble ST2 as a Diagnostic and Prognostic Marker for Acute Heart Failure Syndromes

Queen Henry-Okafor1, Sean P. Collins1, Cathy A. Jenkins1, Karen F. Miller1, David J. Maron1, Allen J. Naftilan1, Neal Weintraub4, Gregory J. Fermann2, John McPherson1, Santosh Menon3, Douglas B. Sawyer1, Alan B. Storrow1, *
1 Department of Cardiovascular Medicine (QHO, DJM, AJN, JM, DBS), the Department of Emergency Medicine (QHO, KFM, DJM, ABS), and the Department of Biostatistics (CAJ), Vanderbilt University School of Medicine, Nashville, TN, USA
2 Department of Emergency Medicine (SPC, NW, GJF), University of Cincinnati, OH, USA
3 Department of Cardiovascular Medicine (SM), The Ohio Heart & Vascular Center, The Christ Hospital in Cincinnati, OH, USA
4 Division of Cardiology, Department of Internal Medicine, University of Cincinnati, OH, USA

© 2012 Henry-Okafor et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Vice Chairman for Research and Academic Affairs Department of Emergency Medicine Vanderbilt University 1313 21st Avenue, South 703 Oxford House Nashville, TN, 37232-4700, USA; Tel: (615) 936-5934; Fax: (615) 936-4490; E-mail:



We investigated the association of sST2 with diagnostic and prognostic outcomes and assessed whether it aids B-natriuretic peptide (BNP) in diagnosing and predicting outcomes in emergency department (ED) patients with suspected AHFS.


We recruited patients who presented to the ED of 3 tertiary hospitals with signs or symptoms of AHFS and met modified Framingham criteria for AHFS. Outcome measures were a final diagnosis of AHFS and 5-and 30-day adverse events.


In the 295 subjects with sST2 available, the median sST2 was 0.20 ng/ml (IQR=0.10, 0.34). Although unadjusted analyses indicated sST2 was significantly associated with the diagnosis of AHFS (p=0.02), this was not so in the adjusted analysis (p=0.33). Moderately low diagnostic utility was noted with an AUC of 0.62 (95% CI=0.56, 0.69). Similar sST2 test characteristics were seen when BNP was restricted between 100 and 500 pg/ml. While sST2 was associated with AHFS readmission at 30-days (p=0.04), in the adjusted analyses it was not associated with adverse events.


In patients with signs or symptoms of AHFS, unadjusted analyses indicated that sST2 was significantly asso-ciated with the diagnosis of AHFS and with 30-day AHFS recidivism. However, the associations did not carry over to ad-justed analyses, and sST2 did not add significant information with regard to explaining the diagnostic and prognostic vari-ability of BNP.

Keywords: Soluble ST2, Acute heart failure, Diagnosis, Prognosis.