Fujisaka Tomohiro, Fujita Shu-Ichi, Maeda Daichi, Shibata Kensaku, Takahashi Hideaki, Morita Hideaki, Takeda Yoshihiro, Ito Takahide, Sohmiya Koichi, Hoshiga Masaaki, Ishizaka Nobukazu
Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Heart Vessels. 2017 Nov;32(11):1327-1336. doi: 10.1007/s00380-017-1002-7. Epub 2017 Jun 6.
Serum levels of the soluble urokinase-type plasminogen activator receptor (suPAR) reflect immune and inflammatory activation, and are shown to be associated with cardiovascular outcomes. We herein investigated the potential association between suPAR and left ventricular diastolic dysfunction among patients with preserved left ventricular ejection fraction (LVEF) and sinus rhythm. Among 291 patients who had sinus rhythm and an LVEF of ≥50% enrolled in the study, 26 (8.9%) were considered to have diastolic dysfunction. Patients with diastolic dysfunction had lower estimated glomerular filtration rate (eGFR), and higher systolic blood pressure (BPs), BNP, C-reactive protein, and suPAR than those without diastolic dysfunction. As compared with the first suPAR quartile, the fourth suPAR quartile was significantly associated with both diastolic dysfunction with an odds ratio of 8.95 [95% confidence interval (CI), 1.04-77.0, P < 0.05] after adjusting for sex, age, BPs log(eGFR), CRP, and diuretic use. On the other hand, receiver-operating characteristic curve (ROC) analysis showed that addition of log(suPAR) to the combination of age, sex, and log(eGFR), CRP, and diuretic use did not significantly improve the prediction of diastolic dysfunction. Among cardiac patients with preserved LVEF, serum suPAR was associated with diastolic dysfunction independent of confounding factors by logistic regression analysis. However, according to the ROC analysis, the utility of suPAR as a biomarker for diastolic dysfunction may be limited from a clinical point of view.
可溶性尿激酶型纤溶酶原激活物受体（suPAR）的血清水平反映免疫和炎症激活情况，且已显示与心血管结局相关。我们在此研究了左心室射血分数（LVEF）保留且为窦性心律的患者中suPAR与左心室舒张功能障碍之间的潜在关联。在该研究纳入的291例窦性心律且LVEF≥50%的患者中，26例（8.9%）被认为存在舒张功能障碍。与无舒张功能障碍的患者相比，有舒张功能障碍的患者估算肾小球滤过率（eGFR）更低，收缩压（BPs）、脑钠肽（BNP）、C反应蛋白和suPAR更高。与suPAR第一四分位数相比，在调整性别、年龄、BPs、log（eGFR）、C反应蛋白（CRP）和利尿剂使用情况后，suPAR第四四分位数与舒张功能障碍显著相关，优势比为8.95[95%置信区间（CI），1.04 - 77.0，P < 0.05]。另一方面，受试者工作特征曲线（ROC）分析表明，在年龄、性别以及log（eGFR）、CRP和利尿剂使用情况的组合中加入log（suPAR）并未显著改善舒张功能障碍的预测。在LVEF保留的心脏病患者中，通过逻辑回归分析，血清suPAR与舒张功能障碍相关且独立于混杂因素。然而，根据ROC分析，从临床角度来看，suPAR作为舒张功能障碍生物标志物的效用可能有限。
