l Risk stratification
In acute and chronic heart failure, ST2 was positively correlated with the Classification of NYHA heart function.
l Prognostic assessment
² In patients with STEMI, an elevated level of ST2 was a strong predictor of cardiovascular death or heart failure through 30 days.
In the quartile analysis, the risk of 30-day cardiovascular death or heart failure increased significantly with an increase in the ST2 quartile, especially in the third and fourth quartiles.
² ST2 can risk assessment of patients with NSTEMI, patients with elevated ST2 levels had a 3-fold increased risk of cardiovascular death and heart failure over the next year.
² The decile analysis of ST2 concentration showed that the 1-year mortality grade of patients with heart failure increased with increasing ST2 concentration, the 1-year mortality rate was more than 50% at the highest decile of ST2.
Compared with the area under the curve of several biomarkers in the PRIDE study for predicting 1-year mortality in patients with heart failure, ST2 has the largest ROC area under the curve.
² In a study of 346 patients with acute heart failure, ST2,NT-proBNP, or BNP levels were measured at baseline to assess the effect of these biomarkers on predicting the risk of death. The highest mortality was observed in the cumulative hazard analysis when both ST2 and natriuretic peptide were elevated（p <0.001）. At low ST2 levels, natriuretic peptide did not predict mortality.
l Guide therapy
² Although BB therapy exerted dose-related benefits across all study participants, sST2 measurement identifies patients with chronic heart failure who may particularly benefit from higher BB doses. Patients with high ST2 concentrations had a lower risk of cardiovascular events when treated with a high dose of the β receptor blocker than when treated with a low dose of the β receptor blocker.
² The effects of aldosterone receptor antagonists were different in different myocardial infarction patients with different levels of ST2. Eplerenone slows ventricular remodeling in patients with high ST2, ST2 can distinguish patients who can get the best drug treatment effect.
l ST2 is not affected by renal function
² Statistics show that, the correlation between ST2 and eGFR is very weak. In multivariate analysis, adjusted for age, sex, NYHA functional class, and LVEF, the correlation between ST2 and eGFR was much lower than that between NT-proBNP and eGFR.
² The ST2 concentration was also not interfered by age, sex, race, body mass index, etc.