Skali Hicham, Gerwien Robert, Meyer Timothy E, Snider James V, Solomon Scott D, Stolen Craig M
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
Critical Diagnostics, San Diego, CA, USA.
J Cardiovasc Transl Res. 2016 Dec;9(5-6):421-428. doi: 10.1007/s12265-016-9713-1. Epub 2016 Oct 31.
Soluble ST2 is an established biomarker of heart failure (HF) progression. Data about its prognostic implications in patients with mildly symptomatic HF eligible to receive cardiac resynchronization therapy defibrillators (CRT-D) are limited. In a cohort of 684 patients enrolled in Multicenter Automated Defibrillator Implantation Trial (MADIT)-CRT, levels of soluble ST2 (sST2) were serially assessed at baseline and 1 year (n = 410). In multivariable-adjusted models, elevated baseline sST2 was associated with an increased risk of death, death or HF, and death or ventricular arrhythmia (VA) even when adjusting for baseline brain natriuretic protein (BNP) levels. In addition, patients with lower baseline sST2 levels had greater risk reduction with CRT-D (p = 0.006). Serial assessment revealed increased risk of VA and death or VA (HR per 10 % increase in sST2 1.11 (1.04-1.20), p = 0.004). Among patients with mildly symptomatic HF and eligibility for CRT-D, baseline and serial assessments sST2 may provide important information for risk stratification.
可溶性ST2是心力衰竭（HF）进展的一种既定生物标志物。关于其在适合接受心脏再同步治疗除颤器（CRT-D）的轻度症状性HF患者中的预后意义的数据有限。在一项纳入多中心自动除颤器植入试验（MADIT）-CRT的684例患者队列中，在基线和1年时（n = 410）对可溶性ST2（sST2）水平进行了连续评估。在多变量调整模型中，即使在校正基线脑钠肽（BNP）水平后，基线sST2升高仍与死亡、死亡或HF以及死亡或室性心律失常（VA）风险增加相关。此外，基线sST2水平较低的患者接受CRT-D后风险降低幅度更大（p = 0.006）。连续评估显示VA以及死亡或VA风险增加（sST2每增加10%，风险比为1.11（1.04 - 1.20），p = 0.004）。在轻度症状性HF且适合接受CRT-D的患者中，基线和连续评估sST2可为风险分层提供重要信息。
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