The Value Of Soluble ST2 Combined With NT-proBNP In Chronic Heart Failure With Preserved And Reduced Ejection Fraction

Objective: The purpose of this study is to observe the expression and correlation of NT-pro BNP and s ST2 in chronic heart failure with preserved ejection fraction and reduced ejection fraction, and to evaluate the predictive value of both in the harmful prognosis of chronic heart failure with preserved ejection fraction and reduced ejection fraction. To provide the objective basis for the application of NT-pro BNP and s ST2 in chronic heart failure with preserved ejection fraction and reduced ejection fraction.Methods: 130 patients with chronic heart failure who admitted in *** hospital from October 2014 to April 2015 and New York Heart assosiation(NYHA) cardiac functional class was II-IV and age was less than 85 years old were included. Male and female were 65 cases respectively. According to the inclusion criteria were divided into HF-PEF group(60 cases) and HF-REF group(70 cases)。The basic clinical data,laboratory data, echocardiographic data in two group were collected. NT-pro BNP and s ST2 were measured respectively using electrochemical immunoassay and double antibody sandwich assay. The follow-up time was 6 months. During the whole follow-up the occurrence of all cause of death and readmission due to heart failure were observed. The data were analyzed by SPSS16.0 statistical software, tests were two-sided test, P <0.05 believes that the difference was statistically significant.Results:1. HF-PEF patients were more common in women, with a history of coronary heart disease, hypertension. The HF-REF patients were more common in male and have more etiologies, and cardiac functional class III-IV were in the majority. 2. The laboratory results between the two groups showed no difference in hemoglobin, fasting blood glucose, total cholesterol, triglyceride, serum creatinine, uric acid. The difference of NT-pro BNP and s ST2 levels between the two groups was statistically significant. The difference of s ST2 levels between the two groups with same cardiac functional class was statistically significant.,and with decreased cardiac function, blood s ST2 level was increased. Echocardiography data were compared between the two groups were shown the difference in the left ventricular ejection fraction(LVEF),the diameter of left ventricular end diastolic and the diameter of left atrium were statistically significant(P<0.05). 3. Correlation analysis: in patients with HF-PEF, s ST2 was only correlated with NT Pro BNP(r==0.615, P = 0.000). In HF-REF groups, s ST2 was correlated with NT Pro BNP and left ventricular end diastolic diameter, left ventricular ejection fraction(r=0.653, 0.374,-0.375, P < 0.05). In the two groups, s ST2 has no obvious correlation with creatinine and age. 4. Follow-up result: There were 44 patients have appeared endpoint events, including readmission patients in 39 cases, all cause of death in 5 cases. Of the endpoint events between the two groups was no significant difference(2c =0.736,P=0.391>0.05).In HF-REF and HF-PEF group, NT-pro BNP and s ST2 levels between event group and non event group were different, the difference was statistically significant(P<0.05). 5. In group HF-REF, the area under the curve of ROC for s ST2 forecasting the occurrence of endpoint was 0.678, the AUC for NT-pro BNP was 0.700, the AUC for NT-pro BNP combined with s ST2 was 0.703, all P <0.05. In the HF-PEF group, the area under the curve of ROC for s ST2 forecasting the occurrence of endpoint was 0.787, the AUC for NT-pro BNP was 0.780, the AUC for NT-pro BNP combined with s ST2 was 0.798, all P <0.05. 6. Survival analysis results: in HF-REF group, endpoint events in patients with high level of s ST2(>0.336ng/ml) and NT-Pro BNP(>4280.5pg/ml) occurred high rate compared with lower level groups, log rank test statistics chi square values were 8.574 vs 8.236 P < 0.05. In HF-PEF group is also the same. endpoint events in patients with high level of s ST2 >0.319ng/ml and NT Pro BNP(>1722.5pg/ml) occurred high rate compared with lower level groups, log rank test statistic chi-square value was 14.093 vs 12.825, P<0.05。Conclusion: 1. Two groups of patients in gender and history of diagnosis, cardiac function classification and diuretic use were different. 2. NT-pro BNP and s ST2 in HF-PEF group were lower than HF-REF group. In the event group and non event group, the levels of NT-pro BNP and s ST2, the former was higher than the latter. In HF-PEF and HF-REF group and the same cardiac function class, s ST2 levels have a significant difference. In HF-PEF, s ST2 was related with the severity of heart failure. 3. In group HF-PEF, only s ST2 was significantly associated with NT-pro BNP, in group HF-REF, s ST2 and NT-pro BNP, ejection fraction and left ventricular end diastolic diameter have correlation. 4. s ST2 and NT-pro BNP have similar prognostic value of HF-PEF and HF-REF, the combination did not improve the predictive value. In HF-PEF and HF-REF, the survival rate of patients with higher levels of s ST2 and NT-pro BNP was lower than patients with low levels of s ST2 and NT-pro BNP. s ST2 and NT-pro BNP were predictors of poor prognosis of HF-PEF and HF-REF.