Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
J Am Coll Cardiol. 2018 Nov 6;72(19):2309-2320. doi: 10.1016/j.jacc.2018.08.2165.
Soluble suppression of tumorigenesis-2 (sST2) is a biomarker related to inflammation and fibrosis.
This study assessed the independent prognostic value of sST2 in chronic heart failure (HF).
Individual patient data from studies that assessed sST2 for risk prediction in chronic HF, together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT), were retrieved.
A total of 4,268 patients were evaluated (median age 68 years, 75% males, 65% with ischemic HF, 87% with left ventricular ejection fraction [LVEF] <40%). NT-proBNP, hs-TnT, and sST2 were 1,360 ng/l (interquartile interval: 513 to 3,222 ng/l), 18 ng/l (interquartile interval: 9 to 33 ng/l), and 27 ng/l (interquartile interval: 20 to 39 ng/l), respectively. During a 2.4-year median follow-up, 1,319 patients (31%) experienced all-cause death (n = 932 [22%] for cardiovascular causes). Among the 4,118 patients (96%) with available data, 1,029 (24%) were hospitalized at least once for worsening HF over 2.2 years. The best sST2 cutoff for the prediction of all-cause and cardiovascular death and HF hospitalization was 28 ng/ml, with good performance at Kaplan-Meier analysis (log-rank: 117.6, 61.0, and 88.6, respectively; all p < 0.001). In a model that included age, sex, body mass index, ischemic etiology, LVEF, New York Heart Association functional class, glomerular filtration rate, HF medical therapy, NT-proBNP, and hs-TnT, the risk of all-cause death, cardiovascular death, and HF hospitalization increased by 26%, 25%, and 30%, respectively, per each doubling of sST2. sST2 retained its independent prognostic value across most population subgroups.
sST2 yielded strong, independent predictive value for all-cause and cardiovascular mortality, and HF hospitalization in chronic HF, and deserves consideration to be part of a multimarker panel together with NT-proBNP and hs-TnT.
可溶性抑制肿瘤发生-2（sST2）是一种与炎症和纤维化相关的生物标志物。
本研究评估了 sST2 在慢性心力衰竭（HF）中的独立预后价值。
检索了评估 sST2 用于慢性 HF 风险预测的研究中的个体患者数据，以及 N 末端 B 型利钠肽前体（NT-proBNP）和高敏肌钙蛋白 T（hs-TnT）。
共评估了 4268 名患者（中位年龄 68 岁，75%为男性，65%为缺血性 HF，87%的左心室射血分数[LVEF]＜40%）。NT-proBNP、hs-TnT 和 sST2 分别为 1360ng/L（四分位间距：513 至 3222ng/L）、18ng/L（四分位间距：9 至 33ng/L）和 27ng/L（四分位间距：20 至 39ng/L）。在中位随访 2.4 年期间，1319 名患者（31%）发生全因死亡（n=932[22%]为心血管原因）。在 4118 名（96%）可获得数据的患者中，1029 名（24%）至少因 HF 恶化住院一次，时间超过 2.2 年。预测全因死亡、心血管死亡和 HF 住院的最佳 sST2 截断值为 28ng/ml，Kaplan-Meier 分析结果良好（对数秩检验：117.6、61.0 和 88.6，均 p＜0.001）。在包括年龄、性别、体重指数、缺血病因、LVEF、纽约心脏协会功能分级、肾小球滤过率、HF 药物治疗、NT-proBNP 和 hs-TnT 的模型中，sST2 每增加一倍，全因死亡、心血管死亡和 HF 住院的风险分别增加 26%、25%和 30%。sST2 在大多数人群亚组中均保持独立的预后价值。
sST2 对慢性 HF 患者的全因和心血管死亡率以及 HF 住院具有较强的独立预测价值，值得考虑与 NT-proBNP 和 hs-TnT 一起作为多标志物组合的一部分。
