Soluble ST2 is a Useful Biomarker for Grading Cerebral–Cardiac Syndrome in Patients after Acute Ischemic Stroke

Abstract

This study tested whether the soluble (s)ST2 is a superb biomarker predictive of moderate to severe cerebral–cardiac syndrome (CCS) (defined as coexisting National Institute of Health Stroke Scale (NIHSS) >8 and left-ventricular ejection fraction (LVEF) <60%) in patients after acute ischemic stroke (IS). Between November 2015 and October 2017, a total of 99 IS patients were prospectively enrolled and categorized into three groups based on NIHSS, i.e., group 1 (NIHSS ≤ 8, n = 66), group 2 (NIHSS = 9-15, n = 14) and group 3 (NIHSS ≥ 16, n = 19), respectively. Blood samples were collected immediately after hospitalization, followed by transthoracic echocardiographic examination. The results showed that the flow cytometric analysis for assessment of inflammatory biomarkers of TLR2+/CD14+cells, TLR4+/CD14+cells, Ly6g+/CD14+cells, and MPO+/CD14+cells, and ELISA assessment for circulatory level of sST2 were significantly higher in groups 2/3 than in group 1 (all p < 0.01). However, these parameters did not show significant differences between groups 2 and 3 (all p > 0.05). The LVEF was significantly lower in group 3 than in group 1 (p < 0.001), but it displayed no difference between groups 1/2 or between groups 2/3. These inflammatory biomarkers ((TLR2+/CD14+cells// TLR4+/CD14+cells// MPO+/CD14+cells) and sST2)) were significantly positively correlated to NIHSS and strongly negatively correlated to LVEF (all p < 0.05). Multivariate analysis demonstrated that both MPO/CD14+cells >20% (p = 0.027) and sST2 ≥ 17,600 (p = 0.004) were significantly and independently predictive of moderate-severe CCS after acute IS. Receiver operating characteristic curve analysis demonstrated that sST2 was the most powerful predictor of CCS with a sensitivity of 0.929 and a specificity of 0.731 (p < 0.001). In conclusion, sST2 is a useful biomarker for prediction of CCS severity in patients after acute IS.

Suppression of tumorigenicity‐2 (ST2) is a promising biomarker in heart transplantation

“…16 Conversely, a report on a smaller cohort from a single-center experience showed that elevated donor's nonhigh sensitivity troponin I serum concentration may be a marker for adverse outcome and increased short-and longterm mortality after HT. 17 Previous reports showed that natriuretic peptides levels were higher in donors whose hearts were declined for transplantation compared with donors whose hearts were considered Recipient M12 28 23 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] .4…”

“…Recently, sST2 has been identified as a useful biomarker for prediction of cerebral-cardiac syn-drome defined as coexisting National Institute of Health Stroke Scale (NIHSS) > 8 and LVEF < 60% in patients after acute ischemic stroke. 27 Thus, sST2 could also be a useful biomarker in the assessment of braindead heart donors and prediction of allograft dysfunction in heart recipients.…”

“…In our series donors’ sST2 serum levels were exceptionally high and higher levels were correlated to PGF in recipients, thus suggesting that brain death leads to a strong inflammatory activation which in turn may contribute to cardiac dysfunction. Recently, sST2 has been identified as a useful biomarker for prediction of cerebral–cardiac syndrome defined as coexisting National Institute of Health Stroke Scale (NIHSS) > 8 and LVEF < 60% in patients after acute ischemic stroke 27 . Thus, sST2 could also be a useful biomarker in the assessment of brain‐dead heart donors and prediction of allograft dysfunction in heart recipients.…”

Soluble Suppression of Tumorigenicity-2 as a Candidate Prognostic Marker for Stroke: A Systematic Review

“…The systematic search of online databases yielded 461 non-duplicate records, and 6 articles were acquired by a manual search. After evaluation, 19 articles were included in this systematic review [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (Fig. 1), of which 10 investigated the value of serum sST-2 measurement in the prediction of the risk of stroke incidence [12][13][14][15][16][17][18][19][20][21], and the remaining 9 evaluated the value of serum sST-2 measurement in the prognosis of post-stroke outcomes [22][23][24][25][26][27][28][29][30].…”

Biomarkers Utility: At the Borderline between Cardiology and Neurology

“…sST2 is also studied as a long-term prognostic marker after an episode of ischemic stroke or transient ischemic attack [109]. Also, it can predict moderate to severe cerebral-cardiac syndrome after an ischemic stroke (coexisting NIHSS > 8 and left ventricular ejection fraction < 60%), likely due to its role in inflammatory cardiovascular diseases and myocardial fibrosis [110]. Furthermore, sST2 proved its efficiency in detecting subclinical brain injury after an incident stroke [111].…”