Department of Cardiology, Yanbian University Hospital, Yanji, China.
Coronary Artery Disease Center, Department of Cardiology, Fuwai Hospital, CAMS and PUMC, Beijing, China.
Medicine (Baltimore). 2024 Mar 1;103(9):e37357. doi: 10.1097/MD.0000000000037357.
This study aimed to examine the changes in serum Low Density Lipoprotein Cholesterol (LDL-C) and Soluble Growth Stimulating Expressed Gene 2 Protein (sST2) among Heart Failure (HF) patients with varying ejection fractions and their clinical significance, providing a reference for the clinical assessment of HF severity.
A total of 238 HF patients treated in our hospital's cardiology department from September 2019 to December 2021 were selected; 68 patients hospitalized in the same period were selected as the control group. General information, LDL-C and echocardiographic results of admitted patients were collected. According to LVEF results and the latest European Society of Cardiology standards in 2021, HF patients were categorized into those with HFpEF (n = 95), HFmrEF (n = 60), and HFrEF (n = 83). Meanwhile, venous blood was collected to determine sST2 and NT-proBNP to compare and analyze the changes and clinical significance of sST2 and LDL-C across the groups.
Compared to the control group, the HF group showed significant differences in age, gender, heart rate, smoking history, history of atrial fibrillation, history of diabetes, LVEDD, LVEF, sST2, and NT-proBNP levels (P < .05), but not in LDL-C levels. Significant differences (P < .05) were also found among the 3 HF groups in terms of age, gender, history of atrial fibrillation, LVEDD, LVEF, LDL-C, sST2, and NT-proBNP levels, with an increase in LVEDD, LDL-C, sST2, and NT-proBNP values as the ejection fraction decreased. ROC curve analysis indicated that the area under the curve (AUC) for sST2 in diagnosing HF was 0.915 (P < .05), with an optimal cutoff value of 23.71 ng/mL, a sensitivity of 76.5%, and a specificity of 95.6%; LDL-C was not a significant diagnostic marker for HF (P > .05). Coronary artery disease, NT-proBNP, and sST2 were identified as risk factors for HF. With each unit increase in coronary artery disease, the risk of HF increased by 36.3%; for NT-proBNP, the risk increased by 1.3% per unit; and for sST2, it increased by 18.3% per unit.
As the ejection fraction decreases in HF patients, serum sST2 and LDL-C values progressively increase, which is clinically significant for predicting the severity of HF. sST2 is an independent risk factor for HF and can enhance the diagnostic accuracy for HF.
本研究旨在探讨不同射血分数心力衰竭（HF）患者血清低密度脂蛋白胆固醇（LDL-C）和可溶性生长刺激表达基因 2 蛋白（sST2）的变化及其临床意义，为 HF 严重程度的临床评估提供参考。
选取 2019 年 9 月至 2021 年 12 月在我院心内科治疗的 238 例 HF 患者为研究对象；同期选取 68 例住院患者作为对照组。收集入院患者的一般资料、LDL-C 和超声心动图结果。根据 LVEF 结果和 2021 年最新的欧洲心脏病学会标准，将 HF 患者分为射血分数保留性心力衰竭（HFpEF，n=95）、中间射血分数心力衰竭（HFmrEF，n=60）和射血分数降低性心力衰竭（HFrEF，n=83）。同时采集静脉血测定 sST2 和 NT-proBNP，比较分析各组 sST2 和 LDL-C 的变化及临床意义。
与对照组比较，HF 组年龄、性别、心率、吸烟史、心房颤动史、糖尿病史、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、sST2、NT-proBNP 水平差异有统计学意义（P<0.05），而 LDL-C 水平差异无统计学意义（P>0.05）。3 组 HF 患者在年龄、性别、心房颤动史、LVEDD、LVEF、LDL-C、sST2、NT-proBNP 水平方面差异均有统计学意义（P<0.05），随着射血分数的降低，LVEDD、LDL-C、sST2、NT-proBNP 值逐渐升高。ROC 曲线分析显示，sST2 诊断 HF 的曲线下面积（AUC）为 0.915（P<0.05），最佳截断值为 23.71ng/mL，敏感度为 76.5%，特异度为 95.6%；LDL-C 不是 HF 的显著诊断标志物（P>0.05）。冠状动脉疾病、NT-proBNP 和 sST2 被确定为 HF 的危险因素。冠状动脉疾病每增加 1 个单位，HF 的风险增加 36.3%；NT-proBNP 每增加 1 个单位，HF 的风险增加 1.3%；sST2 每增加 1 个单位，HF 的风险增加 18.3%。
HF 患者随着射血分数的降低，血清 sST2 和 LDL-C 值逐渐升高，对预测 HF 严重程度具有临床意义。sST2 是 HF 的独立危险因素，可提高 HF 的诊断准确性。
