Unveiling the Silence: Two cases of sST-2-negative Aortic Dissection with Diagnostic Implications

Background Soluble ST2 (sST2) is a biomarker linked to myocardial stress and inflammation, demonstrating potential in the early diagnosis of acute aortic dissection (AAD), often surpassing traditional markers such as D-dimer. Nonetheless, its diagnostic efficacy in real-world settings remains insufficiently characterized. Case Summary: We present two uncommon cases of clinically confirmed AAD: one involving a Stanford type B intramural hematoma and the other an extensive DeBakey type I dissection, both exhibiting unexpectedly low sST2 levels (5.87 ng/mL and 15.94 ng/mL, respectively), significantly below the standard diagnostic threshold of 34.6 ng/mL. Both patients were hemodynamically stable and did not display elevated cardiac biomarkers. Despite the severity and extent of the disease, sST2 did not accurately indicate the presence of aortic pathology. Conclusion : Normal sST2 levels do not exclude the possibility of AAD. These cases highlight the necessity for caution when interpreting sST2 results in isolation and advocate for a comprehensive diagnostic approach that incorporates clinical assessment and imaging techniques. Further research is essential to clarify the diagnostic limitations of sST2 and to enhance biomarker strategies for the evaluation of acute chest pain.