Secemsky Eric A, Scherzer Rebecca, Nitta Elaine, Wu Alan H B, Lange David C, Deeks Steven G, Martin Jeffrey N, Snider James, Ganz Peter, Hsue Priscilla Y
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Medicine, Veteran's Affairs Medical Center, San Francisco, University of California-San Francisco, San Francisco, California.
JACC Heart Fail. 2015 Aug;3(8):591-9. doi: 10.1016/j.jchf.2015.03.007. Epub 2015 Jul 8.
This study sought to determine whether biomarkers ST2, growth differentiation factor (GDF)-15, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin I are elevated in patients infected with human immunodeficiency virus (HIV) and are associated with cardiovascular dysfunction and all-cause mortality.
HIV-infected patients have high rates of cardiovascular disease. Markers of myocardial stress may identify at-risk patients and provide additional prognostic information.
Biomarkers and echocardiograms were assessed in 332 HIV-infected patients and 50 age- and sex-matched control subjects. Left ventricular systolic dysfunction was defined as ejection fraction <50%, diastolic dysfunction (DD) as stage 1 or higher, and pulmonary hypertension as pulmonary artery systolic pressure ≥35 mm Hg. Mortality data were obtained from the National Death Index.
Patients with HIV had a median age of 49 years, and 80% were male. Compared with control subjects, HIV-infected patients had higher adjusted percent estimates of all biomarkers except ST2 and interleukin-6. Among HIV-infected patients, 45% had DD; only ST2 was associated with DD (relative risk [RR]: 1.36; p = 0.047). Left ventricular systolic dysfunction was rare in this cohort (5%). Pulmonary hypertension was present in 27% of HIV-infected patients and was associated with GDF-15 (RR: 1.18; p = 0.04), NT-proBNP (RR: 1.18; p = 0.007), and cystatin C (RR: 1.54; p = 0.03). Thirty-eight deaths occurred among HIV-infected patients over a median of 6.1 years. In adjusted analysis, all-cause mortality was independently predicted by ST2 (hazard ratio [HR]: 2.04; p = 0.010), GDF-15 (HR: 1.42; p = 0.0054), high-sensitivity C-reactive protein (HR: 1.25; p = 0.023), and D-dimer (HR: 1.49; p = 0.029). Relationships were unchanged when analyses were restricted to virally suppressed HIV-infected patients receiving antiretroviral therapy.
Among HIV-infected patients, ST2 and GDF-15 were associated with both cardiovascular dysfunction and all-cause mortality, and these variables may be useful at identifying those at risk for developing cardiovascular events and death.
本研究旨在确定生物标志物ST2、生长分化因子（GDF）-15、N端前脑钠肽（NT-proBNP）和高敏肌钙蛋白I在感染人类免疫缺陷病毒（HIV）的患者中是否升高，以及是否与心血管功能障碍和全因死亡率相关。
HIV感染患者心血管疾病发生率较高。心肌应激标志物可能识别出高危患者并提供额外的预后信息。
对332例HIV感染患者和50例年龄及性别匹配的对照者进行了生物标志物和超声心动图评估。左心室收缩功能障碍定义为射血分数<50%，舒张功能障碍（DD）为1期或更高，肺动脉高压定义为肺动脉收缩压≥35mmHg。死亡率数据来自国家死亡指数。
HIV感染患者的中位年龄为49岁，80%为男性。与对照者相比，除ST2和白细胞介素-6外，HIV感染患者所有生物标志物的校正百分比估计值更高。在HIV感染患者中，45%有DD；只有ST2与DD相关（相对风险[RR]：1.36；p = 0.047）。该队列中左心室收缩功能障碍很少见（5%）。27%的HIV感染患者存在肺动脉高压，且与GDF-15（RR：1.18；p = 0.04）、NT-proBNP（RR：1.18；p = 0.007）和胱抑素C（RR：1.54；p = 0.03）相关。在中位6.1年的时间里，HIV感染患者中有38例死亡。在多因素分析中，全因死亡率由ST2（风险比[HR]：2.04；p = 0.010）、GDF-15（HR：1.42；p = 0.0054）、高敏C反应蛋白（HR：1.25；p = 0.023）和D-二聚体（HR：1.49；p = 0.029）独立预测。当分析仅限于接受抗逆转录病毒治疗且病毒得到抑制的HIV感染患者时，这些关系不变。
在HIV感染患者中，ST2和GDF-15与心血管功能障碍和全因死亡率均相关，这些变量可能有助于识别发生心血管事件和死亡风险的患者。
