生物标志物与超声心动图数据相结合用于预测心脏再同步治疗中左心室逆向重构
Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy.
作者信息
Beltrami Matteo, Galluzzo Alessandro, Bonacchi Giacomo, Checchi Luca, Ricciardi Giuseppe, Perrotta Laura, Garofalo Manuel, Paoletti Perini Alessandro, Mattesini Alessio, Pieragnoli Paolo, Palazzuoli Alberto
机构信息
Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy.
Cardiology Unit, Rivoli Hospital, 10098 Turin, Italy.
出版信息
J Clin Med. 2025 May 16;14(10):3496. doi: 10.3390/jcm14103496.
: Although biomarkers of myocardial fibrosis and inflammation have been proposed as potential modulators of response to cardiac resynchronization therapy (CRT), their clinical utility and interaction with echocardiographic parameters remain incompletely understood. This study aims to assess the dynamic changes in these biomarkers, their relationship with echocardiographic variables, and their association with structural response to CRT. : We retrospectively evaluated 86 consecutive patients referred for CRT with symptomatic heart failure, left ventricular (LV) ejection fraction ≤ 35%, QRS width ≥ 130 ms and LBBB morphology. We measured sST-2, Gal-3, NTpro-BNP and eGFR at baseline and after 1 year of CRT. An echocardiographic reduction of LV end-systolic volume ≥ 15% was used to define a patient as a responder to CRT. : The mean baseline and follow-up values of Gal-3 (responders: 24.1 [16.8;32] ng/mL, non-responders: 30 [20;39.3] ng/mL, = 0.03) and sST2 (responders: 28.5 [20;36] ng/mL, non-responders: 34.5 [25;37.7] ng/mL, = 0.03) were lower in responders than non-responders. Responders showed a significant reduction between baseline and follow-up values of ΔGal-3 (-12.1% vs. -2.5%, = 0.04), ΔsST2 (-30.8% vs. 2.2%, < 0.001), ΔNT-proBNP (-16.4% vs. 5.2, = 0.04) and ΔeGFR (6.7 ± 24.3% vs. -6.3 ± 27.9%, = 0.03). At the multivariate analyses, baseline Gal-3 [cut-off: 38.5 ng/mL, AUC: 0.63, = 0.03, (OR 7.13 [1.12;45.41], = 0.03), together with TAPSE > 17.5 mm (OR 10.86 [3.15;37.44], < 0.001) significantly correlated with the structural response to CRT in several prediction models. Among echocardiographic parameters, TAPSE remained the strongest predictive factor of positive response to CRT at the univariate and multivariate analyses. : In patients with heart failure and reduced ejection fraction undergoing CRT, Gal-3 and TAPSE are significantly associated with a positive structural response to CRT.
尽管心肌纤维化和炎症的生物标志物已被提出作为心脏再同步治疗（CRT）反应的潜在调节因子，但其临床效用以及与超声心动图参数的相互作用仍未完全明确。本研究旨在评估这些生物标志物的动态变化、它们与超声心动图变量的关系以及它们与CRT结构反应的关联。
我们回顾性评估了86例因症状性心力衰竭而接受CRT治疗的连续患者，这些患者左心室（LV）射血分数≤35%，QRS宽度≥130 ms且呈左束支传导阻滞形态。我们在基线时以及CRT治疗1年后测量了可溶性ST2（sST-2）、半乳糖凝集素-3（Gal-3）、N末端脑钠肽前体（NTpro-BNP）和估算肾小球滤过率（eGFR）。左心室收缩末期容积超声心动图减少≥15%被用于定义患者为CRT反应者。
Gal-3（反应者：24.1[16.8；32]ng/mL，无反应者：30[20；39.3]ng/mL，P = 0.03）和sST2（反应者：28.5[20；36]ng/mL，无反应者：34.5[25；37.7]ng/mL，P = 0.03）的平均基线值和随访值在反应者中低于无反应者。反应者在基线值和随访值之间显示出ΔGal-3（-12.1%对-2.5%，P = 0.04）、ΔsST2（-30.8%对2.2%，P < 0.001）、ΔNT-proBNP（-16.4%对5.2，P = 0.04）和ΔeGFR（6.7±24.3%对-6.3±27.9%，P = 0.03）有显著降低。在多变量分析中，基线Gal-3[临界值：38.5 ng/mL，曲线下面积（AUC）：0.63，P = 0.03，（比值比（OR）7.13[1.12；45.41]，P = 0.03）]，连同三尖瓣环平面收缩期位移（TAPSE）>17.5 mm（OR 10.86[3.15；37.44]，P < 0.001）在几个预测模型中与CRT的结构反应显著相关。在超声心动图参数中，在单变量和多变量分析中TAPSE仍然是CRT阳性反应的最强预测因子。
在接受CRT治疗的心力衰竭且射血分数降低的患者中，Gal-3和TAPSE与CRT的阳性结构反应显著相关。
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