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Circulating Soluble ST2 Predicts All-Cause Mortality in Severe Heart Failure Patients with an Implantable
Zhi-Wei Hou1, Hai-Bo Yu1, Yan-Chun Liang1
1Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang 110016, China.
Insights
Soluble ST2 (sST2) levels predict mortality in high-risk heart failure patients receiving implantable cardioverter-defibrillators (ICDs). A threshold of 43.43 ng/ml indicates increased risk, warranting careful monitoring post-implantation.
Area of Science:
- Cardiology
- Biomarker Research
- Medical Device Technology
Background:
- Heart failure (HF) is a critical cardiovascular event.
- Implantable cardioverter-defibrillators (ICDs) reduce mortality in high-risk HF patients.
- Predictive biomarkers are needed for HF patient stratification post-device implantation.
Purpose of the Study:
- Investigate the association between baseline serum soluble ST2 (sST2) levels and clinical outcomes.
- Determine the predictive value of sST2 for mortality in high-risk HF patients with ICDs.
Main Methods:
- Prospective study of 150 HF patients with LVEF ≤35% implanted with ICDs.
- Analysis of baseline serum sST2 and NT-proBNP levels.
- Follow-up for at least 1 year, with all-cause mortality as the primary endpoint.
Main Results:
- All-cause mortality occurred in 10.67% of patients over a 643-day follow-up.
- Elevated sST2 levels (>34.99 ng/ml) significantly increased mortality risk (16.00% vs. 5.33%).
- An sST2 cutoff of 43.43 ng/ml independently predicted all-cause mortality (HR: 3.30), with higher risk above this threshold (21.2% vs. 5.1%).
Conclusions:
- Serum sST2 levels are associated with all-cause mortality risk in HF patients with ICDs.
- An sST2 threshold of 43.43 ng/ml effectively predicts mortality in severe HF.
- Patients with sST2 levels >43.43 ng/ml post-ICD implantation require close monitoring.
Background:
Heart failure (HF) is the terminal stage of all cardiovascular events. Although implantable cardioverter defibrillator (ICD) therapies have reduced mortality among the high-risk HF population, it is necessary to determine whether certain factors can predict mortality even after cardiac device implantation. Growth stimulation expressed gene 2 (ST2) is an emerging biomarker for HF patient stratification in different clinical settings.
Aims:
This study aimed to investigate the relationship between baseline soluble ST2 (sST2) levels in serum and the clinical outcomes of high-risk HF patients with device implantation.
Methods:
Between January 2017 and August 2018, we prospectively recruited consecutive patients implanted with an ICD for heart failure, with LVEF ≤35% as recommended, and analyzed the basic characteristics, baseline serum sST2, and NT-proBNP levels, with at least 1-year follow-up. All-cause mortality was the primary endpoint.
Results:
During a 643-day follow-up, all-cause mortality occurred in 16 of 150 patients (10.67%). Incidence of all-cause mortality increased significantly in patients with sST2 levels above 34.98846 ng/ml (16.00% vs. 5.33%, P = 0.034). After adjusting the model (age, gender, device implantation, prevention of sudden death, LVEDD, LVEF, WBC and CLBBB, hsTNT, etiology, and eGFR) and the model combined with NT-proBNP, the risk of all-cause death was increased by 2.5% and 1.9%, respectively, per ng/ml of sST2. The best sST2 cutoff for predicting all-cause death was 43.42671 ng/ml (area under the curve: 0.72, sensitive: 0.69, and specificity: 0.69). Compared to patients with sST2 levels below 43.42671 ng/ml, the risk of all-cause mortality was higher in those with values above the threshold (5.1% vs. 21.2%, P = 0.002). ST2 level ≥43.42671 ng/ml was an independent predictor of all-cause mortality (HR: 3.30 [95% CI 1.02-10.67]). Age (HR: 1.06 [95% CI: 1.01-1.12]) and increased NT-proBNP per 100 (HR: 1.02 [95% CI: 1.01-1.03]) were also associated with all-cause mortality in ICD patients.
Conclusions:
sST2 level was associated with risk of all-cause mortality, and a threshold of 43.43 ng/ml showed good distinguishing performance to predict all-cause mortality in patients with severe heart failure, recommended for ICD implantation. Patients with sST2 levels more than 43.42671 ng/ml even after ICD implantation should therefore be monitored carefully.
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