Maisel Alan S, Richards A Mark, Pascual-Figal Domingo, Mueller Christian
Veterans Affairs Medical Center, University of California San Diego, San Diego, California.
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Am J Cardiol. 2015 Apr 2;115(7 Suppl):32B-7B. doi: 10.1016/j.amjcard.2015.01.038. Epub 2015 Jan 23.
Biomarkers, particularly natriuretic peptides (NP), complement clinical assessment in patients with heart failure (HF) and may serve as a target level to aid titration of treatment. NP levels that decrease with treatment for acute HF may identify patients at lower risk, but irrespective of the decrease, higher levels at discharge still portend worse outcomes. Beyond NPs, other biomarkers including ST2 have been shown to provide incremental value for prognosis. Although presentation ST2 values are prognostic, admission to discharge change in ST2 and the final ST2 concentration both independently predict patient outcomes in a stronger fashion. Although prognostic thresholds in the hospitalized patient are considerably higher than those used in the office-based setting, a minimum ST2 value of 35 ng/ml is a reasonable starting point for prognosis, noting that many patients will have considerably higher value than this value; as with the NPs, a decreasing value by discharge is desirable, and lower is always better. In conclusion, ST2 values are complementary to NP concentrations, and one can make a good case for serial testing of both biomarkers in the acutely hospitalized patient with HF.
生物标志物，尤其是利钠肽（NP），可辅助心力衰竭（HF）患者的临床评估，并可作为指导治疗滴定的目标水平。急性HF治疗过程中NP水平下降可能提示患者风险较低，但无论其下降与否，出院时较高的NP水平仍预示着更差的预后。除NP外，其他生物标志物（如ST2）已被证明对预后具有额外价值。虽然初始ST2值具有预后意义，但ST2从入院到出院的变化以及最终ST2浓度均能更有力地独立预测患者预后。虽然住院患者的预后阈值远高于门诊患者，但ST2最低值35 ng/ml是一个合理的预后起始点，需注意许多患者的值会远高于此；与NP一样，出院时ST2值下降是理想的，且越低越好。总之，ST2值与NP浓度具有互补性，对于急性住院HF患者，对这两种生物标志物进行系列检测具有充分理由。
