Heart Failure Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Cardiology Division, Medicine Department, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Card Fail. 2015 Apr;21(4):355-61. doi: 10.1016/j.cardfail.2014.10.014. Epub 2014 Nov 3.
Soluble ST2 is involved in multiple pathogenic pathways, including cardiac strain, inflammation, and myocardial necrosis with remodeling. The relative weight of ST2 and the point at which its prognostic value in heart failure (HF) is affected by different degrees of myocardial strain, inflammation, necrosis, and remodeling is unknown.
We examined whether soluble ST2 levels improves HF risk stratification relative to other biomarkers representative of multiple pathogenic pathways-N-terminal pro-B-type natriuretic peptide (NT-proBNP; strain), high-sensitivity C-reactive protein (hsCRP; inflammation), and galectin-3 and high-sensitivity troponin T (hsTnT; necrosis and remodeling)-in 1,015 patients with mean left ventricular ejection fraction (LVEF) 33.5%. Mean follow-up was 4.2 ± 2.1 years. The correlation with soluble ST2 was highest with NT-proBNP (r = 0.32; P < .001) and lowest with galectin-3 (r = 0.15; P < .001). ST2 levels increased with increasing concentrations of the other biomarkers (P < .001 in all cases). During follow-up, 467 patients died. Soluble ST2 remained an independent prognosticator of risk at every tertile of each biomarker. This was observed even after adjusting for clinical parameters.
Soluble ST2 may be regarded as a 3-in-1 prognosis biomarker in HF. ST2 provides valuable long-term risk stratification information in HF beyond that reported by other biomarkers of stretch, inflammation, necrosis, and remodeling.
可溶性 ST2 参与多种致病途径，包括心脏应变、炎症和伴有重塑的心肌坏死。ST2 的相对权重及其在心力衰竭（HF）中的预后价值受不同程度的心肌应变、炎症、坏死和重塑影响的程度尚不清楚。
我们研究了可溶性 ST2 水平是否可以改善 HF 风险分层，与其他代表多种致病途径的生物标志物（N 末端脑利钠肽前体（NT-proBNP；应变）、高敏 C 反应蛋白（hsCRP；炎症）和半乳糖凝集素-3 和高敏肌钙蛋白 T（hsTnT；坏死和重塑）相比，在 1015 名平均左心室射血分数（LVEF）为 33.5%的患者中。平均随访时间为 4.2±2.1 年。与可溶性 ST2 的相关性与 NT-proBNP 最高（r=0.32；P<.001），与半乳糖凝集素-3 最低（r=0.15；P<.001）。ST2 水平随其他生物标志物浓度的增加而增加（在所有情况下均 P<.001）。在随访期间，467 名患者死亡。可溶性 ST2 仍然是每个生物标志物三分位组的独立预后指标。即使在调整了临床参数后，也是如此。
可溶性 ST2 可被视为 HF 的三联预后生物标志物。ST2 提供了比其他应变、炎症、坏死和重塑生物标志物报告的更有价值的 HF 长期风险分层信息。
