ST2 predicts survival in patients undergoing transcatheter aortic valve implantation

Int J Cardiol. 2017 Oct 1;244:87-92. doi: 10.1016/j.ijcard.2017.06.066. Epub 2017 Jun 19.


Objective: To assess soluble suppression of tumorigenicity 2 (sST2) serum concentrations and predict mortality in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: We prospectively enrolled 74 patients with severe aortic stenosis (AS) who underwent TAVI and matched them to patients without aortic valve disease (n=74). AS patients underwent comprehensive echocardiographic and cardiac magnetic resonance imaging and laboratory examinations. sST2 levels were determined by enzyme-linked immunosorbent assay (ELISA), their association with post procedural mortality was investigated using logistic and Cox regression analyses, and the prognostic performance compared to established risk scores.

Results: AS patients had substantially higher sST2 levels than controls (39.5 vs. 17.8ng/mL, p<0.001). sST2 significantly correlated with left and right atrial sizes (r=0.25, p=0.033 and r=0.38, p=0.001). At one and two years, 10 (13.9%) and 18 (25%) patients had died, respectively. sST2 significantly predicted survival in uni- and multivariate Cox regression analyses in our cohort (p=0.005 and p=0.025). sST2 also predicted major adverse cardiovascular events (MACE, p=0.046). Adding sST2 to the established STS score improved prediction of two-year mortality in our cohort (ΔAUC=0.108; 95% CI -0.066-0.281; continuous NRI=0.778; 95% CI: 0.277-1.278 and IDI=0.141; 95% CI: 0.031-0.251), and a model containing both sST2 and the STS score had a negative predictive value of 96.1% and 86.3% regarding one and two-year mortality, respectively.

Conclusions: sST2 is elevated in AS patients and a prognostic marker of survival after TAVI. Implementation of this marker in routine pre-TAVI workup may improve risk prediction and patient selection.

Keywords: Biomarker; Risk stratification; ST2; Survival; Transcatheter aortic valve implantation (TAVI).

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / blood*
  • Aortic Valve Stenosis / mortality*
  • Aortic Valve Stenosis / surgery
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Interleukin-1 Receptor-Like 1 Protein / blood*
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Survival Rate / trends
  • Transcatheter Aortic Valve Replacement / mortality*
  • Transcatheter Aortic Valve Replacement / trends


  • Biomarkers
  • IL1RL1 protein, human
  • Interleukin-1 Receptor-Like 1 Protein