Division of Cardiology, Department of Medicine, University of California at San Diego, San Diego, CA, USA.
Am Heart J. 2010 Oct;160(4):721-8. doi: 10.1016/j.ahj.2010.06.033.
ST2, an interleukin-1 receptor family member up-regulated in the setting of cardiomyocyte strain, has prognostic value in patients with acute myocardial infarction, chronic severe heart failure, and acute heart failure. The predictive value of ST2 levels in outpatients is unknown. We studied the clinical and echocardiographic correlates of ST2 levels and evaluated their prognostic use in outpatients referred for echocardiograms.
ST2 levels were measured in 588 outpatients referred for echocardiogram. Subjects were analyzed by quartile as well as by optimal ST2 cut-point (28.25 ng/mL) derived from receiver operating characteristic curve analysis. All-cause death at 1 year was the primary outcome.
In this cohort with mean age of 68 ± 12 years and median ST2 level of 19.8 ng/mL (interquartile range 15.8-23.7), 25 deaths occurred. Heart rate, creatinine clearance, use of diuretics, and the presence of right ventricular hypokinesis were independently associated with ST2 levels. At 6 months, no patients with ST2 below the median had died. Patients with high ST2 levels had an increased risk of death (adjusted hazard ratio [HR] 2.5, P = .02); those with elevated levels of both ST2 and B-type natriuretic peptide were at even higher risk (adjusted HR 4.3, P = .01 vs none elevated).
ST2 levels reflect right-side heart size and function and are independent predictors of 1-year mortality in outpatients referred for echocardiograms. The optimal cut-point derived in this cohort is comparable with the previously identified prognostic cut-point for sicker patients. ST2 may be an especially strong prognostic marker for short-term mortality risk.
ST2 是白细胞介素-1 受体家族成员之一，在心肌应变的情况下上调，对急性心肌梗死、慢性重度心力衰竭和急性心力衰竭患者具有预后价值。ST2 水平在门诊患者中的预测价值尚不清楚。我们研究了 ST2 水平与临床和超声心动图的相关性，并评估了其在门诊接受超声心动图检查的患者中的预后应用。
测量了 588 名门诊患者的 ST2 水平。根据四分位数和最佳 ST2 切点（28.25ng/ml）进行分析，最佳 ST2 切点来自接受者操作特征曲线分析。1 年全因死亡是主要终点。
在这组平均年龄为 68±12 岁，中位 ST2 水平为 19.8ng/ml（四分位间距 15.8-23.7）的患者中，有 25 例死亡。心率、肌酐清除率、利尿剂的使用和右心室运动功能减退与 ST2 水平独立相关。在 6 个月时，中位 ST2 以下的患者没有死亡。ST2 水平高的患者死亡风险增加（调整后的危险比[HR]2.5，P=0.02）；ST2 和 B 型利钠肽水平均升高的患者风险更高（调整后的 HR 4.3，P=0.01 比均不升高）。
ST2 水平反映右心大小和功能，是门诊接受超声心动图检查患者 1 年死亡率的独立预测因子。在本队列中得出的最佳切点与以前确定的更病重患者的预后切点相当。ST2 可能是短期死亡率风险的一个特别强的预后标志物。
