Hammer Andreas, Marka Frieda, Baumer Ulrike, Hofer Felix, Kazem Niema, Koller Lorenz, Steinacher Eva, Zimpfer Daniel, Andreas Martin, Steinlechner Barbara, Demyanets Svitlana, Niessner Alexander, Sulzgruber Patrick, Stojkovic Stefan
Division of Cardiology, Dept. of Internal Medicine II. Medical University of Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
Division of Cardiology, Dept. of Internal Medicine II. Medical University of Vienna, Austria.
Clin Chim Acta. 2024 Jul 15;561:119815. doi: 10.1016/j.cca.2024.119815. Epub 2024 Jun 13.
Postoperative atrial fibrillation (POAF) represents the most common complication following cardiac surgery. Approximately one-third of patients experiencing POAF transition to atrial fibrillation within a year, challenging the notion of POAF as merely a transient event. Soluble ST2 (sST2) is an established biomarker regarding fibrosis and myocardial stretch, however, its role in predicting the onset of POAF remains unclear.
Preoperative sST2 levels have been assessed in 496 individuals with no prior history of AF who underwent elective cardiac surgery, including valve, coronary artery bypass graft surgery, or a combined procedure.
The average age was 70 years, and 29.4 % were female. Overall, 42.3 % developed POAF. sST2 levels were found to be significantly higher in patients with POAF. Interestingly, sST2 was only predictive of POAF in females with an adjusted OR of 1.894 (95 %CI:1.103-3.253; p = 0.021) and not males (OR:1.091; 95 %CI:0.849-1.402; p = 0.495). Furthermore, within a linear regression model it was observed that for every 1 ng/mL increase in sST2 levels, the average POAF duration extended by 39.5 min (95 %CI:15.8-63.4 min; p = 0.001).
sST2 predicts the onset of POAF in women but not men undergoing cardiac surgery. Furthermore, sST2 levels were associated with the subsequent burden of POAF. Thus, assessment of sST2 in addition to clinical risk factors could improve risk stratification for development of POAF following elective cardiac surgery.
术后房颤（POAF）是心脏手术后最常见的并发症。约三分之一发生POAF的患者在一年内转变为持续性房颤，这对POAF仅仅是一个短暂事件的观念提出了挑战。可溶性ST2（sST2）是一种已确定的关于纤维化和心肌牵张的生物标志物，然而，其在预测POAF发作中的作用仍不清楚。
对496例无房颤病史且接受择期心脏手术（包括瓣膜手术、冠状动脉搭桥手术或联合手术）的个体术前sST2水平进行了评估。
平均年龄为70岁，女性占29.4%。总体而言，42.3%的患者发生了POAF。发现POAF患者的sST2水平显著更高。有趣的是，sST2仅在女性中可预测POAF，校正后的OR为1.894（95%CI：1.103 - 3.253；p = 0.021），而在男性中则无此作用（OR：1.091；95%CI：0.849 - 1.402；p = 0.495）。此外，在线性回归模型中观察到，sST2水平每增加1 ng/mL，POAF平均持续时间延长39.5分钟（95%CI：15.8 - 63.4分钟；p = 0.001）。
sST2可预测接受心脏手术女性而非男性的POAF发作。此外，sST2水平与随后的POAF负担相关。因此，除临床危险因素外，评估sST2可改善择期心脏手术后发生POAF的风险分层。
