Galeone Antonella, Lessana Arrigo, Mascolo Elisa, Di Serio Francesca, Marraudino Nicola, Laborde Francois, Paparella Domenico
Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University "Aldo Moro" of Bari, Italy.
Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France.
Thorac Cardiovasc Surg. 2014 Feb;62(1):47-51. doi: 10.1055/s-0033-1356751. Epub 2013 Sep 24.
ST2 is a member of the interleukin-1 receptor family that is markedly upregulated in cultured cardiomyocytes subjected to mechanical strain. Serum soluble ST2 (sST2) levels can be detected in patients with acute myocardial infarction and severe chronic heart failure. This study sought to assess for the first time the activation of the ST2 pathway in patients with severe chronic degenerative mitral regurgitation.
Serum sST2 levels were measured in 20 patients scheduled for mitral valve (MV) repair at baseline, at the end of the intervention, on postoperative day 1, at hospital discharge, and after 6 months. Patients also underwent measurement of N-terminal pro-brain natriuretic peptide and echocardiographic evaluation at each time point.
At baseline, sST2 was detected in 10 (50%) patients (mean value, 60 ± 74 pg/mL; range, 0-234 pg/mL; median, 8 pg/mL). MV repair was performed successfully in all patients. Cardiac surgery with cardiopulmonary bypass was associated with a rapid and transient increase in sST2 levels. Patients with baseline higher versus lower sST2 levels (≥ 8 vs. < 8 pg/mL) had significantly higher levels of sST2 on postoperative day 1 (1,050 ± 593 vs. 440 ± 312 pg/mL; p = 0.009). At follow-up, patients with preoperative sST2 ≥ 8 pg/mL had significantly higher ejection fraction (EF) (64.7 ± 5.8 vs. 57.6 ± 5.9; p = 0.03) and lower left ventricular end-diastolic diameter (LVEDD) (50.6 ± 5.8 vs. 56 ± 4.2; p = 0.03) compared with patients with preoperative sST2 < 8 pg/mL.
Preoperative ST2 activation, evidenced by the presence of serum sST2 levels, is present in half of the patients with chronic degenerative mitral regurgitation and is associated with higher levels of EF and lower levels of LVEDD after MV repair.
ST2是白细胞介素-1受体家族的成员，在受到机械应变的培养心肌细胞中显著上调。急性心肌梗死和严重慢性心力衰竭患者可检测到血清可溶性ST2（sST2）水平。本研究首次旨在评估严重慢性退行性二尖瓣反流患者中ST2通路的激活情况。
对20例计划进行二尖瓣（MV）修复的患者在基线、干预结束时、术后第1天、出院时和6个月后测量血清sST2水平。患者在每个时间点还进行了N末端脑钠肽前体测量和超声心动图评估。
基线时，10例（50%）患者检测到sST2（平均值，60±74 pg/mL；范围，0 - 234 pg/mL；中位数，8 pg/mL）。所有患者MV修复均成功。体外循环心脏手术与sST2水平快速短暂升高有关。基线sST2水平较高与较低的患者（≥8 vs. <8 pg/mL）术后第1天的sST2水平显著更高（1,050±593 vs. 440±312 pg/mL；p = 0.009）。随访时，术前sST2≥8 pg/mL的患者与术前sST2<8 pg/mL的患者相比，射血分数（EF）显著更高（64.7±5.8 vs. 57.6±5.9；p = 0.03），左心室舒张末期内径（LVEDD）更低（50.6±5.8 vs. 56±4.2；p = 0.03）。
血清sST2水平的存在证明术前ST2激活存在于一半的慢性退行性二尖瓣反流患者中，并且与MV修复后较高的EF水平和较低的LVEDD水平相关。
