Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Mathematics, Cleveland State University, Cleveland, Ohio.
JACC Heart Fail. 2016 Jan;4(1):68-77. doi: 10.1016/j.jchf.2015.07.015. Epub 2015 Dec 2.
The study sought to investigate the association between soluble growth stimulation expressed gene 2 (sST2) level and adverse outcomes in acute heart failure (HF).
Several studies have demonstrated the prognostic utility of sST2 levels in HF.
sST2 levels were measured in sequential baseline and follow-up (48 to 72 h and 30 days) plasma samples from 858 acute HF subjects enrolled in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial biomarker substudy and were related to in-hospital and post-discharge clinical outcomes.
Higher sST2 levels were associated with increased death risk at 180 days (baseline hazard ratio [HR]: 2.21; follow-up HR: 2.64; both p < 0.001). These results were not independent of covariates and aminoterminal pro-B-type natriuretic peptide for baseline sST2 (HR: 1.29, p = 0.243), but were borderline significant for follow-up sST2 (HR: 1.61, p = 0.051). Subjects with persistently high (>60 ng/ml) sST2 levels at follow-up had higher 180-day death rates than those with lower follow-up sST2 levels (adjusted HR: 2.91, p = 0.004). Neither baseline nor follow-up sST2 levels were associated with dyspnea improvement. Changes in sST2 from baseline were less in the nesiritide versus placebo group at follow-up, but were similar at 30 days.
Elevated levels of sST2 were associated with an increased risk of adverse clinical events in acute HF, but prognostic value of baseline sST2 diminished after adjusting for clinical covariates and aminoterminal pro-B-type natriuretic peptide. In those with elevated baseline sST2 levels, persistently elevated sST2 levels at follow-up were associated with increased mortality risk. In addition, nesiritide did not demonstrate an incremental impact on sST2 levels over standard therapy.
本研究旨在探讨可溶性生长刺激表达基因 2（sST2）水平与急性心力衰竭（HF）不良结局之间的关系。
多项研究已经证实了 sST2 水平在 HF 中的预后价值。
在 ASCEND-HF（急性心力衰竭失代偿期奈西立肽临床疗效研究）试验的生物标志物亚研究中，连续测量了 858 名急性 HF 患者基线和随访（48 至 72 小时和 30 天）血浆样本中的 sST2 水平，并将其与住院和出院后临床结局相关联。
较高的 sST2 水平与 180 天的死亡风险增加相关（基线危险比[HR]：2.21；随访 HR：2.64；均 p<0.001）。这些结果不受协变量和氨基末端 pro-B 型利钠肽的影响，但对随访 sST2 具有边缘显著意义（HR：1.61，p=0.051）。在随访时 sST2 持续升高（>60ng/ml）的患者，其 180 天死亡率高于 sST2 水平较低的患者（校正 HR：2.91，p=0.004）。基线和随访 sST2 水平均与呼吸困难改善无关。与安慰剂组相比，奈西立肽组随访时 sST2 的变化较小，但在 30 天时相似。
sST2 水平升高与急性 HF 不良临床事件风险增加相关，但在调整临床协变量和氨基末端 pro-B 型利钠肽后，基线 sST2 的预后价值降低。在基线 sST2 水平升高的患者中，随访时持续升高的 sST2 水平与死亡风险增加相关。此外，奈西立肽并未显示对 sST2 水平产生标准治疗的增量影响。
