Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Beijing Anzhen Hospital, Capital Medical University; Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Centre for Cardiovascular Disorders; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Can J Cardiol. 2019 Jun;35(6):727-735. doi: 10.1016/j.cjca.2019.02.016. Epub 2019 Feb 27.
Prognosis in patients with pediatric dilated cardiomyopathy (PDCM) is urgently required to identify high-risk patients. Elevated soluble ST2 (sST2) is associated with prognosis in adult patients with heart failure. This study aimed to assess the prognostic value of sST2 in PDCM.
Ninety-four patients with PDCM were enrolled after admission from 2 centres in China and followed up for adverse events (death, cardiac transplantation, and heart-failure-related rehospitalization). B-type natriuretic peptide (BNP) and sST2 levels were measured.
Over a median of 678 (interquartile range [IQR]: 533-785) days, 28 (29.8%) adverse events occurred. Patients in the highest tertile of sST2 levels had increased risk of short-term (< 6 months) (adjusted hazard ratio [HR]: 8.36, 95% confidence interval [CI], 1.02-73.52; P < 0.05) and long-term adverse events (2 years) (adjusted HR: 4.23; 95% CI, 1.32-13.60; P < 0.01) than those in lower tertiles. The C-statistic was increased with addition of sST2 to BNP from 0.697 (95% CI, 0.541-0.852) to 0.812 (95% CI, 0.697-0.939) for short-term and from 0.712 (95% CI, 0.604-0.819) to 0.798 (95% CI, 0.697-0.899) for prediction of long-term adverse events. An intermediate-risk subgroup was identified, and 24% had adverse events. When serial measurements were taken in a nested case-control subgroup, sST2 levels were constantly high in patients with late adverse events (> 6 months) but gradually decreased in nonadverse-event controls compared with 3-month and 6-month baseline levels.
In patients with PDCM, serum sST2 levels are associated with adverse events and have robust prognostic value. Serial measurements of sST2 could help in managing patients for monitoring outcomes of treatment.
小儿扩张型心肌病（PDCM）患者的预后需要确定高危患者。可溶性 ST2（sST2）升高与成人心力衰竭患者的预后相关。本研究旨在评估 sST2 在 PDCM 中的预后价值。
在中国的 2 个中心入院后，共纳入 94 例 PDCM 患者进行不良事件（死亡、心脏移植和心力衰竭相关再住院）随访。测量 B 型利钠肽（BNP）和 sST2 水平。
中位随访 678（IQR：533-785）天，28 例（29.8%）发生不良事件。sST2 水平最高三分位的患者发生短期（<6 个月）（校正后的危险比[HR]：8.36，95%置信区间[CI]，1.02-73.52；P<0.05）和长期（2 年）不良事件（校正后的 HR：4.23；95%CI，1.32-13.60；P<0.01）的风险高于低三分位患者。sST2 增加至 BNP 后，短期的 C 统计量从 0.697（95%CI，0.541-0.852）增加至 0.812（95%CI，0.697-0.939），长期从 0.712（95%CI，0.604-0.819）增加至 0.798（95%CI，0.697-0.899）。确定了一个中等风险亚组，24%的患者发生了不良事件。在嵌套病例对照亚组中进行系列测量时，与 3 个月和 6 个月的基线水平相比，晚期不良事件（>6 个月）患者的 sST2 水平持续升高，而非不良事件对照组的 sST2 水平逐渐降低。
在 PDCM 患者中，血清 sST2 水平与不良事件相关，具有可靠的预后价值。sST2 的连续测量有助于监测治疗结局，管理患者。
