Yang Shaomin, Chen Haixiong, Tan Kuan, Cai Fusheng, Du Yongxing, Lv Weibiao, Hu Qiugen, Hu Yunzhao, Huang Yuli
Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China.
Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China.
Oxid Med Cell Longev. 2020 May 6;2020:2563508. doi: 10.1155/2020/2563508. eCollection 2020.
Quantification of extracellular volume (ECV) fraction by cardiovascular magnetic resonance (CMR) has emerged as a noninvasive diagnostic tool to assess myocardial fibrosis. Secreted frizzled-related protein 2 (SFRP2) appears to play an important role in cardiac fibrosis. We aimed to evaluate the association between SFRP2 and myocardial fibrosis and the prognostic value of ECV fraction in patients with heart failure (HF).
In this prospective cohort study, 72 hospitalized adult patients (age ≥ 18 years) with severe decompensated HF were included. CMR measurements and T1 mapping were performed to calculate ECV fraction. Serum SFRP2 level was detected by an enzyme-linked immunosorbent assay kit. All patients were followed up, and the primary outcomes were composite events including all-cause mortality and HF hospitalization.
During the median follow-up of 12 months, 27 (37.5%) patients experienced primary outcome events and had higher levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), SFRP2, and ECV fraction compared with those without events. In Pearson correlation analysis, levels of SFRP2 ( = 0.33), high-sensitivity C-reactive protein ( = 0.31), and hemoglobin A1c ( = 0.29) were associated with ECV fraction (all < 0.05); however, in multivariate linear regression analysis, SFRP2 was the only significant factor determined for ECV fraction ( = 0.33, = 0.02). In multivariate Cox regression analysis, age (each 10 years, hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.04-1.22), ECV fraction (per doubling, HR 1.68, 95% CI 1.03-2.74), and NT-proBNP (per doubling, HR 2.46, 95% CI 1.05-5.76) were independent risk factors for primary outcomes.
Higher ECV fraction is associated with worsened prognosis in HF. SFRP2 is an independent biomarker for myocardial fibrosis. Further studies are needed to explore the potential therapeutic value of SFRP2 in myocardial fibrosis.
通过心血管磁共振成像（CMR）定量细胞外容积（ECV）分数已成为评估心肌纤维化的一种非侵入性诊断工具。分泌型卷曲相关蛋白2（SFRP2）似乎在心脏纤维化中起重要作用。我们旨在评估SFRP2与心肌纤维化之间的关联以及ECV分数在心力衰竭（HF）患者中的预后价值。
在这项前瞻性队列研究中，纳入了72例年龄≥18岁、因严重失代偿性HF住院的成年患者。进行CMR测量和T1映射以计算ECV分数。采用酶联免疫吸附测定试剂盒检测血清SFRP2水平。对所有患者进行随访，主要结局为包括全因死亡率和HF住院在内的复合事件。
在12个月的中位随访期内，27例（37.5%）患者发生主要结局事件，与未发生事件的患者相比，这些患者的N末端B型利钠肽原（NT-proBNP）、SFRP2和ECV分数水平更高。在Pearson相关性分析中，SFRP2水平（r = 0.33）、高敏C反应蛋白水平（r = 0.31）和糖化血红蛋白水平（r = 0.29）与ECV分数相关（均P < 0.05）；然而，在多变量线性回归分析中，SFRP2是唯一确定的与ECV分数相关的显著因素（β = 0.33，P = 0.02）。在多变量Cox回归分析中，年龄（每增加10岁，风险比（HR）1.13，95%置信区间（CI）1.04 - 1.22）、ECV分数（每增加一倍，HR 1.68，95% CI 1.03 - 2.74）和NT-proBNP（每增加一倍，HR 2.46，95% CI 1.05 - 5.76）是主要结局的独立危险因素。
较高的ECV分数与HF患者预后较差相关。SFRP2是心肌纤维化的独立生物标志物。需要进一步研究探索SFRP2在心肌纤维化中的潜在治疗价值。
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