LAUSR

Circulation. 2018;138:1280. DOI: 10.1161/CIRCULATIONAHA.118.034582 1280 https://www.ahajournals.org/journal/circ Li Zhang, MD Xiao-mao Xu, MD To the Editor: We read with great interest the article presented by Yuan Wang and colleagues1 about soluble ST2 (sST2) as a novel biomarker for acute aortic dissection. In this study, sST2 showed superior overall diagnostic performance for acute aortic dissection over D-dimer or cardiac troponin I within 24 hours of presentation to the emergency department. We have 2 suggestions about this article. First, Nazerian and colleagues2 presented the results of aortic dissection detection risk score plus D-dimer in diagnosis of acute aortic dissection, which might possibly rule out diagnostic strategies for acute aortic dissection. Because sST2 is superior to D-dimer in diagnostic performance for acute aortic dissection, can we combine aortic dissection detection risk score with sST2 to make the diagnosis of acute aortic dissection more accurate? Second, this article indicated that in the acute phase, sST2 was most elevated in patients with acute aortic dissection and modestly elevated in patients with other causes of acute chest pain such as pulmonary embolism and acute myocardial infarction. Is sST2 level related to the type of pulmonary embolism and acute myocardial infarction? Will sST2 elevation be more obvious in the condition of massive pulmonary embolism and extensive myocardial infarction for which accurate differential with acute aortic dissection diagnosis is more important?