Perspective:

This is an interesting study on what many have started to call death markers, which include ST2, GDF-15, and Pro-ADM. This study focused on those with diastolic abnormalities predominantly. This is fortunate because the marker did not appear useful in those with reduced LV systolic function. In contrast, in those with diastolic abnormalities, ST2 was predictive of mortality and performed as in some other studies, and was better than NT-proBNP in that regard. However, only 29% of a relatively small group had decompensated heart failure, and the mode of death was not defined for the cohort. Thus, despite a relationship between values and some of the echocardiographic measures that might point toward a cardiovascular etiology for long-term events, this concept cannot be considered furthered by this analysis. ST2 is clearly a death marker and may well work better than NT-proBNP because it detects those at risk regardless of the presence of decompensated heart failure. However, how to use it properly will depend on determining how it works and what is its appropriate use.