Cortés Marcelino, Lumpuy-Castillo Jairo, García-Talavera Camila Sofía, Arroyo Rivera María Belén, de Miguel Lara, Bollas Antonio José, Romero-Otero Jose Maria, Esteban Chapel Jose Antonio, Taibo-Urquía Mikel, Pello Ana María, González-Casaus María Luisa, Mahíllo-Fernández Ignacio, Lorenzo Oscar, Tuñón José
Cardiology Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain.
Faculty of Medicine and Biomedicine, Universidad Alfonso X el Sabio (UAX), 28691 Madrid, Spain.
Int J Mol Sci. 2025 Jan 24;26(3):986. doi: 10.3390/ijms26030986.
Natriuretic peptides are established biomarkers related to the prognosis of heart failure. New biomarkers have emerged in the field of cardiovascular disease. The prognostic value of these biomarkers in heart failure with reduced left ventricular ejection fraction is not well-established. We conducted a prospective, single-centre study, including (July 2019 to March 2023) 104 patients being consecutively admitted with a diagnosis of acute heart failure with reduced ejection fraction decompensation. The median follow-up was 23.5 months, during which 20 deaths (19.4%) and 21 readmissions for heart failure (20.2%) were recorded. Plasma biomarkers, such as NT-proBNP, GDF-15, sST2, suPAR, and FGF-23, were associated with an increased risk of all-cause mortality. However, a Cox regression analysis showed that the strongest predictors of mortality were an estimated glomerular filtration rate (HR 0.96 [0.93-0.98]), GDF-15 (HR 1.3 [1.16-1.45]), and sST2 (HR 1.2 [1.11-1.35]). The strongest predictive model was formed by the combination of the glomerular filtration rate and sST2 (C-index 0.758). In conclusion, in patients with acute decompensated heart failure with reduced ejection fraction, GDF-15 and sST2 showed the highest predictive power for all-cause mortality, which was superior to other established biomarkers such as natriuretic peptides. GDF-15 and sST2 may provide additional prognostic information to improve the prognostic assessment.
利钠肽是与心力衰竭预后相关的既定生物标志物。心血管疾病领域已出现新的生物标志物。这些生物标志物在左心室射血分数降低的心力衰竭中的预后价值尚未明确确立。我们进行了一项前瞻性单中心研究，纳入（2019年7月至2023年3月）104例因射血分数降低的急性心力衰竭失代偿而连续入院的患者。中位随访时间为23.5个月，在此期间记录到20例死亡（19.4%）和21例因心力衰竭再次入院（20.2%）。血浆生物标志物，如NT-proBNP、GDF-15、sST2、suPAR和FGF-23，与全因死亡风险增加相关。然而，Cox回归分析显示，死亡率的最强预测因素是估计肾小球滤过率（HR 0.96 [0.93 - 0.98]）、GDF-15（HR 1.3 [1.16 - 1.45]）和sST2（HR 1.2 [1.11 - 1.35]）。肾小球滤过率和sST2的组合形成了最强的预测模型（C指数0.758）。总之，在射血分数降低的急性失代偿性心力衰竭患者中，GDF-15和sST2对全因死亡率显示出最高的预测能力，优于钠尿肽等其他既定生物标志物。GDF-15和sST2可能提供额外的预后信息以改善预后评估。
