Fabiani Iacopo, Conte Lorenzo, Pugliese Nicola Riccardo, Calogero Enrico, Barletta Valentina, Di Stefano Rossella, Santoni Tatiana, Scatena Cristian, Bortolotti Uberto, Naccarato Antonio Giuseppe, Petronio Anna Sonia, Di Bello Vitantonio
Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy.
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100, Pisa, Italy.
Int J Cardiovasc Imaging. 2017 Dec;33(12):1915-1920. doi: 10.1007/s10554-017-1203-2. Epub 2017 Jun 29.
Aortic valve stenosis (AVS) is associated with significant myocardial fibrosis (MF). Global longitudinal strain (GLS) is a sensible indicator of systolic dysfunction. ST2 is a member of the interleukin (IL)-1 receptor family and a modulator of hypertrophic and fibrotic responses. We aimed at assessing: (a) the association between adverse LV remodeling, LV functional parameters (including GLS) and sST2 level. (b) The association between MF (detected by endo-myocardial biopsy) and sST2 in patients with AVS undergoing surgical valve replacement. Twenty-two patients with severe AVS and preserved EF underwent aortic valve replacement. They performed laboratory analysis, including serum ST2 (sST2), echocardiography and inter-ventricular septum biopsy to assess MF (%). We included ten controls for comparison. Compared to controls, patients showed higher sST2 levels (p < 0.0001). sST2 showed correlation with Age (r = 0.58; p = 0.0004), E/e' average (r = 0.58; p = 0.0007), GLS (r = 0.61; p = 0.0002), LAVi (r = 0.51; p = 0.003), LVMi (r = 0.43; p = 0.01), sPAP (r = 0.36; p = 0.04) and SVi (r = -0.47; p < 0.005). No correlation was found between MF and sST2. At ROC analysis, a sST2 ≥ 284 ng/mL had the best accuracy to discriminate controls from patients with impaired GLS, i.e. GLS ≤ 17% (AUC 0.80; p = 0.003; sensitivity 95%; specificity 83%) and increased E/e' average (AUC 0.87; p = 0.0001; sensitivity 96%; specificity 74%). At multivariate regression analysis GLS resulted the only independent predictor of sST2 levels (R = 0.35; p = 0.0004). Patients with severe AVS present elevated sST2 levels. LV GLS resulted the only independent predictor of sST2 levels.
主动脉瓣狭窄（AVS）与显著的心肌纤维化（MF）相关。整体纵向应变（GLS）是收缩功能障碍的一个敏感指标。ST2是白细胞介素（IL）-1受体家族的成员，也是肥厚和纤维化反应的调节因子。我们旨在评估：（a）左心室不良重塑、左心室功能参数（包括GLS）与可溶性ST2（sST2）水平之间的关联。（b） 在接受外科瓣膜置换的AVS患者中，心肌纤维化（通过心内膜心肌活检检测）与sST2之间的关联。22例重度AVS且射血分数保留的患者接受了主动脉瓣置换。他们进行了实验室分析，包括血清ST2（sST2）、超声心动图和室间隔活检以评估心肌纤维化（%）。我们纳入了10名对照进行比较。与对照组相比，患者的sST2水平更高（p＜0.0001）。sST2与年龄（r = 0.58；p = 0.0004）、E/e'平均值（r = 0.58；p = 0.0007）、GLS（r = 0.61；p = 0.0002）、左房容积指数（LAVi，r = 0.51；p = 0.003）、左室心肌质量指数（LVMi，r = 0.43；p = 0.01）、收缩期肺动脉压（sPAP，r = 0.36；p = 0.04）和每搏输出量指数（SVi，r =−0.47；p＜0.005）相关。未发现心肌纤维化与sST2之间存在相关性。在ROC分析中，sST2≥284 ng/mL在区分对照组与GLS受损（即GLS≤17%）的患者时具有最佳准确性（AUC 0.80；p = 0.003；敏感性95%；特异性83%），以及在区分对照组与E/e'平均值升高的患者时也具有最佳准确性（AUC 0.87；p = 0.0001；敏感性96%；特异性74%）。在多变量回归分析中，GLS是sST2水平的唯一独立预测因子（R = 0.35；p = 0.0004）。重度AVS患者的sST2水平升高。左心室GLS是sST2水平的唯一独立预测因子。
