Kurlianskaya E K, Mrochek A G, Denisevich T L, Kaliadka M G, Russkich I I
Republican Scientific and Practical Center "Cardiology".
Kardiologiia. 2020 Feb 4;60(1):16-22. doi: 10.18087/cardio.2020.1.n882.
Objective Investigate the role of biomarkers in the prognosis of the clinical course of the disease in patients with chronic heart failure (CHF) of different NYHA functional classes (FC).Material and Methods The study included 132 patients with CHF: Group 1 was composed of 70 patients with NYHA FC II CHF, and Group 2 included 62 patients with FC III-IV CHF. The patients underwent clinical, instrumental, functional, and laboratory measurements, which included serum concentrations of NT-proBNP, ST-2, galectin-3, and C-reactive protein. Patients were examined at baseline and at 3, 6, and 12 mos of follow-up. The following cardiac complications were used as endpoints: urgent hospitalization due to decompensated CHF, heart transplantation, cardiovascular death. Endpoints were registered during the 12-mo follow-up period.Results Endpoints were recorded for 58 patients (44%) of the total sample of patients with CHF: 38 patients were urgently hospitalized, 10 patients underwent heart transplantation, 10 patients died. Cardiac complications were recorded at a higher rate in patients with FC III-IV CHF (63% vs. 27% of patients with FC II; p<0.001). In FC II CHF patients, the incidence of cardiac complications was significantly correlated with NT-proBNP blood concentrations (Rpb=0.53; p=0.023), left ventricular end-diastolic volume (LVEDV) (Rpb=0.50; p=0.044), and mitral regurgitation (Rpb=0.53; p=0.038). Cardiac complications in patients with FC III-IV CHF were associated with ST-2 (Rpb=0.52; p=0.004) and galectin-3 (Rpb=0.46; p=0.009) blood concentrations, and with systolic pulmonary artery pressure (PAP) (Rpb=0.41; p=0.014). Unlike other laboratory measurements, galectin-3 concentrations were significantly correlated with type 2 diabetes mellitus (DM2) (Rpb=0.40; p=0.003). In this study, correlation analysis and evidence of significant differences in the concentrations of biomarkers provided a rationale for identifying potential predictors of severe cardiac complications during medium- and long-term follow-up periods in patients with CHF of different severity: NT-proBNP concentrations in FC II patients; ST-2 and galectin-3 serum concentrations in FC III-IV patients; galectin-3 concentrations in patients with CHF and DM2.Conclusion NT-proBNP blood concentrations are associated with CHF severity and serious cardiac complications in patients with FC II CHF within the following 12 mos. The poor prognosis of FC III-IV CHF is associated with the concentration of the ST-2 biomarker. The blood concentration of galectin-3 is a significant predictor of poor prognosis in patients with CHF and DM2. Predictors of the adverse course of CHF of varying severity were differentiated. For FC II CHF, NT-proBNP > 1723 pg/ml or, if NT-proBNP < 1723 pg/mL, then EDV > 311 ml. For FC III-IV CHF, ST-2 > 67 ng/mL or, if ST-2 < 67 ng/mL, then PAP > 61 mm Hg. Galectin-3 has a prognostic value for the clinical course of the disease at different follow-up periods in patients with CHF and DM2: galectin-3 concentrations > 16 ng/mL and 13-16 ng/mL are risk factors for mid- and long-term cardiac complications, respectively.
目的 探讨生物标志物在不同纽约心脏协会（NYHA）心功能分级（FC）的慢性心力衰竭（CHF）患者疾病临床进程预后中的作用。
材料与方法 本研究纳入132例CHF患者：第1组由70例NYHA FC II级CHF患者组成，第2组包括62例FC III-IV级CHF患者。患者接受了临床、仪器检查、功能和实验室测量，包括血清NT-proBNP、ST-2、半乳糖凝集素-3和C反应蛋白浓度。在基线以及随访3、6和12个月时对患者进行检查。以下心脏并发症用作终点指标：因CHF失代偿而紧急住院、心脏移植、心血管死亡。在12个月的随访期内记录终点指标。
结果 在CHF患者总样本中，58例（44%）记录到终点指标：38例患者紧急住院，10例患者接受心脏移植，10例患者死亡。FC III-IV级CHF患者心脏并发症的发生率更高（FC II级患者为63%，而FC II级患者为27%；p<0.001）。在FC II级CHF患者中，心脏并发症的发生率与NT-proBNP血浓度（Rpb=0.53；p=0.023）、左心室舒张末期容积（LVEDV）（Rpb=0.50；p=0.044）和二尖瓣反流（Rpb=0.53；p=0.038）显著相关。FC III-IV级CHF患者的心脏并发症与ST-2（Rpb=0.52；p=0.004）和半乳糖凝集素-3（Rpb=0.46；p=0.009）血浓度以及收缩期肺动脉压（PAP）（Rpb=0.41；p=0.014）相关。与其他实验室测量不同，半乳糖凝集素-3浓度与2型糖尿病（DM2）显著相关（Rpb=0.40；p=0.003）。在本研究中，相关性分析以及生物标志物浓度显著差异的证据为识别不同严重程度CHF患者中长期随访期间严重心脏并发症的潜在预测指标提供了理论依据：FC II级患者中的NT-proBNP浓度；FC III-IV级患者中的ST-2和半乳糖凝集素-3血清浓度；CHF合并DM2患者中的半乳糖凝集素-3浓度。
结论 在接下来的12个月内，NT-proBNP血浓度与FC II级CHF患者的CHF严重程度和严重心脏并发症相关。FC III-IV级CHF的不良预后与ST-2生物标志物的浓度相关。半乳糖凝集素-3血浓度是CHF合并DM2患者预后不良的重要预测指标。区分了不同严重程度CHF不良病程的预测指标。对于FC II级CHF，NT-proBNP>1723 pg/ml，或者如果NT-proBNP<1723 pg/mL，则EDV>311 ml。对于FC III-IV级CHF，ST-2>67 ng/mL，或者如果ST-2<67 ng/mL，则PAP>61 mmHg。半乳糖凝集素-3对CHF合并DM2患者在不同随访期的疾病临床进程具有预后价值：半乳糖凝集素-3浓度>16 ng/mL和13-16 ng/mL分别是中长期心脏并发症的危险因素。
