Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, Pisa, 56124, Italy.
Cardiology Division, Pisa University Hospital, Pisa, Italy.
ESC Heart Fail. 2022 Aug;9(4):2084-2095. doi: 10.1002/ehf2.13883. Epub 2022 May 5.
To define plasma concentrations, determinants, and optimal prognostic cut-offs of soluble suppression of tumorigenesis-2 (sST2), high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in women and men with chronic heart failure (HF).
Individual data of patients from the Biomarkers In Heart Failure Outpatient Study (BIOS) Consortium with sST2, hs-cTnT, and NT-proBNP measured were analysed. The primary endpoint was a composite of 1 year cardiovascular death and HF hospitalization. The secondary endpoints were 5 year cardiovascular and all-cause death. The cohort included 4540 patients (age 67 ± 12 years, left ventricular ejection fraction 33 ± 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/mL, P < 0.001) and hs-cTnT level (15 vs. 20 ng/L, P < 0.001), and similar concentrations of NT-proBNP (1540 vs. 1505 ng/L, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut-off was lower in women for sST2 (28 vs. 31 ng/mL) and hs-cTnT (22 vs. 25 ng/L), while NT-proBNP cut-off was higher in women (2339 ng/L vs. 2145 ng/L). The use of sex-specific cut-offs improved risk prediction compared with the use of previously standardized prognostic cut-offs and allowed to reclassify the risk of many patients, to a greater extent in women than men, and for hs-cTnT than sST2 or NT-proBNP. Specifically, up to 18% men and up to 57% women were reclassified, by using the sex-specific cut-off of hs-cTnT for the endpoint of 5 year cardiovascular death.
In patients with chronic HF, concentrations of sST2 and hs-cTnT, but not of NT-proBNP, are lower in women. Lower sST2 and hs-cTnT and higher NT-proBNP cut-offs for risk stratification could be used in women.
定义可溶性肿瘤抑制因子-2（sST2）、高敏心肌肌钙蛋白 T（hs-cTnT）和 N 末端脑钠肽前体（NT-proBNP）在女性和男性慢性心力衰竭（HF）患者中的血浆浓度、决定因素和最佳预后截断值。
对 Biomarkers In Heart Failure Outpatient Study（BIOS）联盟中 sST2、hs-cTnT 和 NT-proBNP 测量的个体患者数据进行分析。主要终点是 1 年心血管死亡和 HF 住院的复合终点。次要终点是 5 年心血管和全因死亡。该队列包括 4540 名患者（年龄 67±12 岁，左心室射血分数 33±13%，1111 名女性，25%）。女性的 sST2（24 比 27ng/ml，P<0.001）和 hs-cTnT 水平（15 比 20ng/L，P<0.001）较低，而 NT-proBNP 浓度相似（1540 比 1505ng/L，P=0.408）。尽管这三种生物标志物在两性中均被证实为独立的预后预测因子，但 sST2（28 比 31ng/ml）和 hs-cTnT（22 比 25ng/L）的最佳预后截断值在女性中较低，而 NT-proBNP 的截断值在女性中较高（2339ng/L 比 2145ng/L）。与使用先前标准化的预后截断值相比，使用性别特异性截断值可改善风险预测，并能更准确地重新分类许多患者的风险，尤其是女性比男性，hs-cTnT 比 sST2 或 NT-proBNP 更准确。具体来说，使用 hs-cTnT 的性别特异性截断值，男性中有 18%，女性中有 57%的患者可以重新分类，达到 5 年心血管死亡的终点。
在慢性 HF 患者中，sST2 和 hs-cTnT 的浓度，而不是 NT-proBNP 的浓度，在女性中较低。用于风险分层的较低 sST2 和 hs-cTnT 以及较高的 NT-proBNP 截断值可用于女性。
