Beaudoin Jonathan, Szymonifka Jackie, Lavender Zachary, Deaño Roderick C, Zhou Qing, Januzzi James L, Singh Jagmeet P, Truong Quynh A
Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, QC, Canada.
Department of Biostatistics, New York University, New York, NY, USA.
J Thorac Dis. 2019 Dec;11(12):5362-5371. doi: 10.21037/jtd.2019.11.66.
Pulmonary hypertension (PH) is an adverse prognostic marker in patients undergoing cardiac resynchronization therapy (CRT). We sought to determine the relation of biomarkers of fibrosis [soluble ST2 (sST2), galectin-3], wall stretch [amino terminal pro-brain natriuretic peptide (NT-proBNP)], and necrosis [high-sensitivity troponin-I (hsTnI)] to PH severity in CRT patients.
Biomarkers and right ventricular systolic pressure (RVSP) were measured at CRT implant and 6-month later (n=111). PH was categorized into 3 groups based on RVSP: no (<35 mmHg), mild-moderate (35-60 mmHg), and severe (>60 mmHg). Patients were categorized as progressors (worsened PH), persistent PH (no change) and regressors (improved PH). Endpoints were 6-month CRT response and 2-year major adverse cardiac event (MACE).
RVSP was associated with CRT nonresponse (P=0.02) and MACE (P=0.03). Severe PH patients had 5-fold increase risk for CRT nonresponse (OR 5.0, P=0.04) and MACE (HR 5.7, P=0.04) over non-PH patients. Progressors and persistent PH patients had >2-fold odds for CRT non-response (OR 2.8, P=0.45) and >11-fold increase in MACE compared to no PH patients or regressors (HR 11.6, P=0.02). Only NT-proBNP and sST2 were discernable between PH groups, with graded increase based on PH severity (both P≤0.02), and lower values in regressors versus non-regressors (both P≤0.01). Levels of sST2 decreased at 6 months in regressors (15 ng/mL, P=0.03) and increased slightly (3-8 ng/mL) in non-regressors, without difference for NT-proBNP (P=0.08).
sST2 levels are related with PH severity in CRT patients. Serial sST2 changes after CRT implant suggests potential role to monitor PH after CRT.
肺动脉高压（PH）是接受心脏再同步治疗（CRT）患者的不良预后标志物。我们试图确定纤维化生物标志物[可溶性ST2（sST2）、半乳糖凝集素-3]、室壁牵张[氨基末端脑钠肽前体（NT-proBNP）]和坏死[高敏肌钙蛋白I（hsTnI）]与CRT患者PH严重程度之间的关系。
在CRT植入时及6个月后测量生物标志物和右心室收缩压（RVSP）（n = 111）。根据RVSP将PH分为3组：无PH（<35 mmHg）、轻度至中度PH（35 - 60 mmHg）和重度PH（>60 mmHg）。患者分为病情进展者（PH恶化）、持续性PH（无变化）和病情缓解者（PH改善）。观察终点为6个月CRT反应和2年主要不良心脏事件（MACE）。
RVSP与CRT无反应（P = 0.02）和MACE（P = 0.03）相关。与无PH患者相比，重度PH患者CRT无反应风险增加5倍（OR 5.0，P = 0.04），MACE风险增加5.7倍（HR 5.7，P = 0.04）。与无PH患者或病情缓解者相比，病情进展者和持续性PH患者CRT无反应几率增加>2倍（OR 2.8，P = 0.45），MACE增加>11倍（HR 11.6，P = 0.02）。仅NT-proBNP和sST2在不同PH组间有差异，且随PH严重程度分级增加（均P≤0.02），病情缓解者的值低于非病情缓解者（均P≤0.01）。病情缓解者sST2水平在6个月时下降（15 ng/mL，P = 0.03），非病情缓解者略有升高（3 - 8 ng/mL），NT-proBNP无差异（P = 0.08）。
sST2水平与CRT患者的PH严重程度相关。CRT植入后sST2的系列变化提示其在监测CRT后PH方面的潜在作用。
