Elevated Serum Levels of Soluble ST2 Are Associated With Plaque Vulnerability in Patients With Non-ST-Elevation Acute Coronary Syndrome

Abstract

Background: Recent studies have suggested that soluble suppression of tumorigenicity-2 (sST2), an inflammation-related protein receptor, is associated with atherosclerotic diseases. This study aimed to investigate the potential predictive value of sST2 on plaque vulnerability by assessing whether elevated serum levels of sST2 are associated with vulnerable plaque features in patients with non-ST-elevation acute coronary syndrome (ACS).Methods: A total of 120 patients with non-ST-elevation ACS (167 lesions) were prospectively enrolled and evaluated by standard coronary computed tomography angiography (CCTA) and coronary angiography in this study. Serum sST2 levels were measured by ELISA (Presage® ST2 Assay Kit, Critical Diagnostics), and semiautomated software (QAngioCT, Medis) was used to quantify coronary plaques.Results: The included patients were divided into 4 groups by serum sST2 level quartiles. Volumetric analysis of the whole lesion revealed that patients with higher sST2 levels had a larger absolute necrotic core (NC) volume (Quartile 4 vs. Quartile 1, 86.16 ± 59.71 vs. 45.10 ± 45.80 mm3, P = 0.001; Quartile 4 vs. Quartile 2, 86.16 ± 59.71 vs. 50.22 ± 42.56 mm3, P = 0.002) and a higher NC percentage (Quartile 4 vs. Quartile 1, 35.16 ± 9.82 vs. 23.21 ± 16.18%, P < 0.001; Quartile 4 vs. Quartile 2, 35.16 ± 9.82% vs. 22.50 ± 14.03%, P < 0.001; Quartile 4 vs. Quartile 3, 35.16 ± 9.82% vs. 25.04 ± 14.48%, P < 0.001). Correlation analysis revealed that serum sST2 levels were positively correlated with the NC (r = 0.323, P < 0.001) but negatively correlated with dense calcium (r = −0.208, P = 0.007). Furthermore, among those with plaque calcification, patients with spotty calcification exhibited higher serum sST2 levels than those with large calcification (26.06 ± 16.54 vs. 17.55 ± 7.65 ng/mL, P = 0.002). No significant differences in plaque components at the level of the minimal lumen area (MLA) were found among the groups.Conclusions: Serum sST2 levels were correlated with different coronary plaque components in patients with non-ST-elevation ACS. A higher serum level of sST2 was correlated with plaque vulnerability.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04797819.

Novel Biomarkers in Evaluating Cardiac Function in Patients on Hemodialysis—A Pilot Prospective Observational Cohort Study

“…In the face of this evolution, one should expect that patients on maintenance HD present a longer period of a pro-atherosclerotic calcification status; thus, they most likely would present the final stage of atherosclerotic plaque evolution, plaque macrocalcification. Considering that mitral valve calcification mechanisms are similar to the ones from large plaque calcifications, our results seem natural and confirm the previous published data, as elevated sST2 levels seem to be correlated with spotty calcifications and not with large ones [ 47 ]. These results require further confirmation in prospective studies with larger number of patients in order to reduce bias and/or positive results due to chance.…”

“…Some studies evaluated the imbrication of sST2 and atherosclerotic plaque calcifications. For instance, Luo showed that in patients with non-ST-elevated acute coronary syndrome, higher levels of sST2 were associated with spotty atherosclerotic calcifications, and those with lower levels exhibited large plaque calcifications [ 47 ]. In our study, there is a negative connection between sST2 levels and mitral valve calcifications.…”

Soluble ST2 in coronary artery disease: Clinical biomarkers and treatment guidance

“…Based on the above studies, Luo et al prospectively enrolled 120 patients to assess plaque vulnerability by coronary computed tomography angiography (CCTA) ( 26 ). Their study showed that higher serum sST2 levels were associated with higher plaque vulnerability.…”

Soluble ST2 and its relation to inflammatory, vascular atherosclerotic, and calcification markers in patients with atrial fibrillation or heart failure at moderate-to-high cardiovascular risk

“…Correlation analysis revealed significant positive associations between sST2 and CACS for both CACS groups (Pearson r=0.288, p=0.036 for CACS=0; Pearson r=0.237, p=0.039 for CACS>0). Luo et al reported similar results in patients with non-ST-elevation acute coronary syndrome [36]. They found higher serum sST2 levels among patients with spotty plaque calcification, than those with large calcification.…”