Admission Soluble ST2 and Its Correlation with NT-Probnp and Hscrp in Acute Heart Failure and Acute Myocardial Infarction: A Prospective Observational Study

Abstract

Background: Natriuretic peptides such as NT-proBNP are the standard biomarkers for diagnosis and prognosis in heart failure, but their concentrations are influenced by age, renal function, and body-mass index. Soluble suppression of tumorigenicity-2 (sST2), a marker of myocardial fibrosis and remodelling, has emerged as a complementary, load-independent prognostic biomarker in heart failure, but data relating admission sST2 to NT-proBNP and high-sensitivity C-reactive protein (hsCRP), and to clinical outcomes, in Indian patients with acute heart failure (AHF) and acute myocardial infarction (MI) are scarce.

Aim and Objectives: To assess the correlation of admission sST2 with NT-proBNP and hsCRP in patients with acute heart failure and acute myocardial infarction. To evaluate the prognostic value of admission sST2 for in-hospital mortality, length of hospital stay, and 3-month mortality and readmission in this population.

Methodology:

Study Design: Prospective observational study. Study Setting: Tertiary cardiac-care centre, Latur, Maharashtra. Study Population: Consecutive patients older than 18 years admitted with acute heart failure (AHF, n=75) or acute myocardial infarction (MI, n=75); patients with pregnancy, cirrhosis, chronic pulmonary disease, rheumatic valvular heart disease, collagen vascular disease or rheumatoid arthritis, or septic shock were excluded. Study period: 2 April 2025 to 2 April 2026. Sample Size = 150. sST2, NT-proBNP, hsCRP, and troponin I were measured within 6 hours of hospitalisation. Correlations were assessed using Spearman's method; group medians were compared using the Mann-Whitney U test or Kruskal-Wallis H test. Patients were followed for in-hospital and 3-month outcomes (mortality and readmission).

Results: Of 150 patients (89 [59.3%] men, 61 [40.7%] women; mean age 65.61 ± 12.85 years), admission sST2 correlated positively with NT-proBNP (r=0.871) and hsCRP (r=0.860; both p<0.001) and negatively with left ventricular ejection fraction (r=-0.878, p<0.001) across the whole cohort, with similar directionally consistent correlations in the AHF and MI groups separately. Median sST2 was higher in patients who died in hospital than in survivors (228.5 vs 107.5 ng/mL, p<0.001), in those with a longer hospital stay (215.0 vs 116.0 ng/mL, p<0.001), and in those who died (215.5 vs 105.0 ng/mL, p=0.004) or were readmitted (204.0 vs 102.0 ng/mL, p<0.001) within 3 months.

Conclusions: In this Indian cohort, admission sST2 tracked closely with established biomarkers of myocardial wall stress and systemic inflammation and identified patients at higher risk of in-hospital death, prolonged hospital stay, and adverse 3-month outcomes in both AHF and MI. These findings support consideration of sST2 as an adjunct, relatively load-independent prognostic marker alongside NT-proBNP and hsCRP, while highlighting the need for population-specific reference ranges and larger multicentre validation.