Park Sohyeon, Kim In-Cheol, Kim Hyungseop, Cho Yun-Kyeong, Lee Cheol Hyun, Hur Seung-Ho
Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
Heart Vessels. 2022 Feb;37(2):173-183. doi: 10.1007/s00380-021-01905-z. Epub 2021 Aug 3.
The association of the soluble suppression of tumorigenicity 2 (sST2) and the prognosis of heart failure have been well evaluated. However, little is known about the prediction of sST2 for left ventricular (LV) remodeling in acute coronary syndrome (ACS). We investigated the ability of sST2 to predict LV remodeling following the revascularization of ACS. From May 2019 to December 2020, 95 patients with LV ejection fraction (EF) < 50% who underwent coronary revascularization for ACS (unstable angina, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction) were enrolled. Echocardiography and sST2 were performed at baseline and at a 3-month follow-up. The association between LV remodeling, using the end-diastolic volume index, and sST2 at baseline and at the 3-month follow-up, and the difference between each value was explored. During follow-up, 41 patients showed LV adverse remodeling. The baseline sST2 increased in patients without adverse remodeling (32.05 ng/mL vs. 23.5 ng/mL, p < 0.001), although clinical characteristics were similar between the two groups. During the mean follow-up of 3 months, a significant correlation was found in the changes between sST2 and LV end-diastolic/systolic volume index (r = 0.649; p < 0.001, r = 0.618; p < 0.001, respectively), but not in the changes of LVEF (r = - 0.132, p = 0.204). The use of angiotensin-converting enzyme 2 inhibitors/receptor blockers was higher (90.7% vs. 53.7%, p < 0.001) and sST2 decreased more predominantly in patients without adverse remodeling (23.18 ng/mL vs 26.40 ng/mL, p = 0.003). However, the changes in sST2 and LV volume were not different according to the ACS types (p > 0.05, for all). Estimates of the odds ratio (OR) for remodeling according to the sST2 difference increased substantially with a negative increase in the sST2 difference. Multivariable analysis found that, the difference between the baseline and 3-month sST2 was the most important determinant of LV remodeling following the revascularization of ACS (OR 1.24; 95% confidence interval: 1.09 to 1.41; p = 0.001). In conclusion, an increase in sST2 during follow-up was a useful predictor of LV remodeling.
可溶性肿瘤抑制因子2（sST2）与心力衰竭预后的关联已得到充分评估。然而，关于sST2对急性冠状动脉综合征（ACS）患者左心室（LV）重构的预测作用却知之甚少。我们研究了sST2预测ACS血管重建术后LV重构的能力。2019年5月至2020年12月，纳入95例左心室射血分数（EF）<50%且因ACS（不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死）接受冠状动脉血管重建术的患者。在基线和3个月随访时进行超声心动图检查和sST2检测。探讨了使用舒张末期容积指数评估LV重构与基线及3个月随访时sST2之间的关联，以及各值之间的差异。随访期间，41例患者出现LV不良重构。尽管两组临床特征相似，但无不良重构患者的基线sST2升高（32.05 ng/mL对23.5 ng/mL，p<0.001）。在平均3个月的随访期间，发现sST2变化与LV舒张末期/收缩末期容积指数变化之间存在显著相关性（r分别为0.649；p<0.001，r为0.618；p<0.001），但与LVEF变化无关（r=-0.132，p=0.204）。无不良重构患者使用血管紧张素转换酶2抑制剂/受体阻滞剂的比例更高（90.7%对53.7%，p<0.001），且sST2下降更为明显（23.18 ng/mL对26.40 ng/mL，p=0.003）。然而，根据ACS类型，sST2和LV容积的变化并无差异（所有p>0.05）。根据sST2差异对重构的比值比（OR）估计随着sST2差异的负向增加而大幅上升。多变量分析发现，基线与3个月时sST2的差异是ACS血管重建术后LV重构的最重要决定因素（OR 1.24；95%置信区间：1.09至1.41；p=0.001）。总之，随访期间sST2升高是LV重构的有效预测指标。
