可溶性 ST2 预测慢性心力衰竭伴左心室收缩功能障碍患者的心脏性猝死。
Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic dysfunction.
机构信息
Cardiology Service, Virgen de la Arrixaca Hospital and Department of Medicine, University of Murcia, Murcia 30120, Spain.
出版信息
J Am Coll Cardiol. 2009 Dec 1;54(23):2174-9. doi: 10.1016/j.jacc.2009.07.041.
OBJECTIVES
We studied whether the measurement of the soluble form of ST2 (sST2), an interleukin-1 receptor family member, could identify heart failure (HF) patients at risk of sudden cardiac death (SCD).
BACKGROUND
The prediction of SCD remains an important challenge in patients with mild-to-moderate chronic HF. Concentrations of sST2 have been found increased and related to worse long-term outcomes in patients with acute HF. Whether sST2 has a prognostic role in SCD is unknown.
METHODS
A nested case-control study was performed on 36 cases of SCD and 63 control patients (matched for age, sex, and left ventricular ejection fraction) obtained from the MUSIC (MUerte Súbita en Insuficiencia Cardíaca) registry, a 3-year multicenter registry of ambulatory HF patients (New York Heart Association functional class II to III, left ventricular ejection fraction < or =45%). Demographic, clinical, echocardiographic, electrical, and biochemical data were collected at enrollment.
RESULTS
Concentrations of sST2 were greater among decedents (0.23 ng/ml [interquartile range 0.16 to 0.43 ng/ml] vs. 0.12 ng/ml [interquartile range 0.06 to 0.23 ng/ml], p = 0.001) and were predictive of experiencing SCD (+0.1 ng/ml, odds ratio: 1.39, 95% confidence interval: 1.09 to 1.78, p = 0.006). On the basis of a combined biomarker status, only 4% of patients experienced SCD for neither sST2 nor N-terminal pro-B-type natriuretic peptide (NT-proBNP) above receiver-operator characteristic-derived cut-off points (0.15 ng/ml and 2,000 ng/l, respectively), 34% for either biomarker above, and 71% for both biomarkers above (p < 0.001 for trend). This combined variable added incremental prognostic value to the multivariable regression model (p < 0.001).
CONCLUSIONS
Elevated sST2 concentrations are predictive of SCD in patients with chronic HF and provide complementary information to NT-proBNP levels. A combined biomarker approach may have an impact on clinical decision-making.
目的
我们研究了白细胞介素-1 受体家族成员可溶性 ST2（sST2）的测定是否可以识别心力衰竭（HF）患者发生心源性猝死（SCD）的风险。
背景
预测 SCD 仍然是轻度至中度慢性 HF 患者的重要挑战。在急性 HF 患者中，发现 sST2 浓度升高并与预后不良相关。sST2 是否对 SCD 具有预后作用尚不清楚。
方法
一项巢式病例对照研究纳入了 36 例 SCD 患者和 63 例对照患者（年龄、性别和左心室射血分数匹配），这些患者来自 MUSIC（心力衰竭导致的猝死）注册研究，这是一项为期 3 年的门诊 HF 患者多中心注册研究（纽约心脏协会功能分级 II 至 III 级，左心室射血分数 < 或 =45%）。在登记时收集人口统计学、临床、超声心动图、电生理和生化数据。
结果
死亡者的 sST2 浓度更高（0.23ng/ml [四分位间距 0.16 至 0.43ng/ml] 与 0.12ng/ml [四分位间距 0.06 至 0.23ng/ml]，p=0.001），并且可预测 SCD 发生（+0.1ng/ml，比值比：1.39，95%置信区间：1.09 至 1.78，p=0.006）。基于联合生物标志物状态，只有 4%的患者既没有 sST2 也没有氨基末端 B 型利钠肽前体（NT-proBNP）高于基于受试者工作特征曲线得出的截断点（分别为 0.15ng/ml 和 2000ng/l），34%的患者有一个生物标志物高于截断点，71%的患者两个生物标志物均高于截断点（趋势检验 p<0.001）。这种联合变量为多变量回归模型增加了额外的预后价值（p<0.001）。
结论
慢性 HF 患者中升高的 sST2 浓度可预测 SCD，并为 NT-proBNP 水平提供补充信息。联合生物标志物方法可能对临床决策产生影响。
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