Circulating levels and prognostic cut-offs of sST2, hs-cTnT, and NT-proBNP in women vs. men with chronic heart failure

Giuseppe Vergaro*, Francesco Gentile, Alberto Aimo, James L Januzzi, A Mark Richards, Carolyn S P Lam, Rudolf A de Boer, Laura M G Meems, Roberto Latini, Lidia Staszewsky, Inder S Anand, Jay N Cohn, Thor Ueland, Lars Gullestad, Pål Aukrust, Hans-Peter Brunner-La Rocca, Antoni Bayes-Genis, Josep Lupón, Akiomi Yoshihisa, Yasuchika TakeishiMichael Egstrup, Ida Gustafsson, Hanna K Gaggin, Kai M Eggers, Kurt Huber, Greg D Gamble, Lieng H Ling, Kui Toh Gerard Leong, Poh Shuah Daniel Yeo, Hean Yee Ong, Fazlur Jaufeerally, Tze P Ng, Richard Troughton, Robert N Doughty, Gerry Devlin, Mayanna Lund, Alberto Giannoni, Claudio Passino, Michele Emdin

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


AIMS: To define plasma concentrations, determinants, and optimal prognostic cut-offs of soluble suppression of tumorigenesis-2 (sST2), high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in women and men with chronic heart failure (HF).

METHODS AND RESULTS: Individual data of patients from the Biomarkers In Heart Failure Outpatient Study (BIOS) Consortium with sST2, hs-cTnT, and NT-proBNP measured were analysed. The primary endpoint was a composite of 1 year cardiovascular death and HF hospitalization. The secondary endpoints were 5 year cardiovascular and all-cause death. The cohort included 4540 patients (age 67 ± 12 years, left ventricular ejection fraction 33 ± 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/mL, P < 0.001) and hs-cTnT level (15 vs. 20 ng/L, P < 0.001), and similar concentrations of NT-proBNP (1540 vs. 1505 ng/L, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut-off was lower in women for sST2 (28 vs. 31 ng/mL) and hs-cTnT (22 vs. 25 ng/L), while NT-proBNP cut-off was higher in women (2339 ng/L vs. 2145 ng/L). The use of sex-specific cut-offs improved risk prediction compared with the use of previously standardized prognostic cut-offs and allowed to reclassify the risk of many patients, to a greater extent in women than men, and for hs-cTnT than sST2 or NT-proBNP. Specifically, up to 18% men and up to 57% women were reclassified, by using the sex-specific cut-off of hs-cTnT for the endpoint of 5 year cardiovascular death.

CONCLUSIONS: In patients with chronic HF, concentrations of sST2 and hs-cTnT, but not of NT-proBNP, are lower in women. Lower sST2 and hs-cTnT and higher NT-proBNP cut-offs for risk stratification could be used in women.

Original languageEnglish
Pages (from-to)2084-2095
Number of pages12
JournalEsc heart failure
Issue number4
Early online date5 May 2022
Publication statusPublished - Aug 2022


  • Chronic heart failure
  • High-sensitivity troponin T
  • NT-proBNP
  • Prognosis
  • SEX
  • Sex
  • Women
  • sST2

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