Biomarkers play an important role in management of heart failure (HF). Soluble ST2 as a further biomarker has been increasingly investigated in the past years, with known prognostic effect in pulmonary hypertension or in heart failure in conjunction with natriuretic peptides. In our study we aimed to examine survival of patients with elevated ST2 levels depending on right ventricular dysfunction, described as reduced TAPSE <17mm (Tricuspid annular plane systolic excursion) and/or basal RVEDD <42mm (right-ventricular end-diastolic diameter).

In our retrospective registry, we gathered data from 83 subjects with heart failure of various clinical presentation, etiology, and phenotype. Clinical and functional of right heart parameters of TAPSE and RVEDD were obtained. Survival over 4 years was examined for a combined end point of all-cause mortality, hospital admission due to heart failure, heart transplantation and LVAD implantation. Values of soluble ST2 were measured instantly using a point of care device.

Majority of subjects were men (66.3%), mean age was 64.9 +/- 16.8 years. Mean ST2 was 76 ng/ml +/- 66.43 ng/ml. Mean TAPSE was 16.33 +/- 5mm and mean RVEDD was 42.09 +/- 7mm. Presentation of heart failure was mostly chronic (n=42, 50.6%), followed by acute HF (n=32, 38.6%) and cardiogenic shock (n=9, 10.8%). Phenotypes of heart failure were HFrEF (n=54, 65.1%), HFmrEF (n=9, 10.8%) and HFpEF (n=20, 24.1%). Etiology was predominantly non ischemic (n=65, 78.3%).

ST2 did not give additional prognosis information in patients with present or absent RV dysfunction (log rank comparison within groups of normal vs elevated ST2 and present vs absent RV dysfunction: p= 0.193 and 0.737). In multivariable Cox regression, ST2 and TAPSE proved to be predictor of survival, with RV dysfunction showing greater prognostic effect (ST2: p = 0.035 and for TAPSE p= 0.004).

In conclusion, ST2 and RV dysfunction are predictors of survival in patients with different presentations, types and etiologies of heart failure, with TAPSE showing a greater prognostic effect. Elevation of ST2 did not serve as a survival predictor in patients with or without RV dysfunction.