The Level Change And Clinical Significance Of Serum SST2 In Chronic Heart Failure Patients With Atrial Fibrillation

Objective The purpose of this study is to observe the expression level change of serum sST2 in chronic heart failure patients with atrial fibrillation,to explore the relationship between serum sST2 with other clinical data,to evaluate the diagnostic and prognostic value of chronic heart failure patients with atrial fibrillation,so that a basis for treatment maybe provided.Method 118 chronic heart failure patients who were admitted to Fujian medical university affiliated Quanzhou first hospital from January 2016 to August 2016 were included continuously,whose New York Heart association(NYHA)cardiac functional class was II-IV,aged 18 to 85,in whom Male and female were 69 cases VS 49 cases respectively.The patients were divided into HF-af group and HF-sr group based on whether complicated with atrial fibrillation.Meanwhile the study also had been named in 54 cases for physical examination as a control group,in whom Male and female were 24 cases VS 30 cases respectively.Clinical data of three groups,such as subjects,laboratory biochemical examination,echocardiographic,electrocardiogram and chest X-ray data,etc,were respectively collected.sST2 were measured by double antibody sandwich enzyme-linked immuno sorbent assay(ELISA).The follow-up period was 6 months(180 days),the follow-up occurrence was defined as all-cause mortality and readmission due to heart failure.The data were analyzed by SPSS 22.0 statistical software,tests were two-sided test,P < 0.05 believes that the difference was statistically significant.Result 1.Baseline data comparison:This study showed no difference in sex among the three group.Mean age and heart rate showed no significant difference between HF-af group and HF-sr group,but both two group were higher than control group.There was no significant difference between HF-af group and HF-sr group in systolic pressure,sign,cardiac functional class,diabetes,the using of angiotensin converting enzyme inhibitor / angiotensin receptor blocker and beta blockers.The using of diuretics and spironolactone in HF-af patients were more than HF-sr group,P < 0.05.2.The levers of sST2 in HF-af group and HF-sr group were higher than control group,P < 0.05,but it shows no significant difference between HF-af group and HF-sr group.3.There was no significant difference in sST2 levels between HF-af group and HF-sr group with the same cardiac functional class,while in the same group,as cardiac function class increased,sST2 levels increased,P < 0.05.4.It showed no significant difference in sST2 levels between HF-af group and HF-sr group with same heart failure subtype,but it showed difference between two subtype.In HFr EF group sST2 level was higher than that in HFp EF group,P<0.05.5.Correlation analysis: in HF-af group and HF-sr group,sST2 was negatively correlated with left ventricular ejection fraction(r=-0.493,P < 0.05 VS r=-0.480,P<0.05).And sST2 level was positively correlated with BNP(r=0.509,P< 0.05 VS r = 0.588,P < 0.05).6.Follow-up results: there were 27 patients had occurred endpoint events,18 cases with HF-af and 9 cases with HF-sr.The endpoint events between the two groups showed significant difference(?2= 3.890,P < 0.05).The sST2 level in event group was higher than that of non event group,P < 0.05.7.In HF-af group,the area under the curve of receiver operating characteristic(ROC)for sST2 diagnosising the desease was 0.732,P < 0.05.The best cutoff value was 33.20 ng/ml,sensitivity and specificity were 0.763 and 0.690 respectively.8.In HF-af group,the area under the curve of ROC for sST2 forecasting the occurrence of endpoint events was 0.846,P < 0.05.The best cutoff value was 60.43 ng/ml,sensitivity and specificity were 0.778 and 0.690 respectively.9.Survival analysis results: in HF-af group,endpoint events in patiens with high level of sST2(> 60.43 ng/ml)occurred with higher rate compared with low level group,log-rank test statistics Chi-Square values was 34.10,P <0.05.ConclusionFor heart failure patients,whether or not complicated with atrial fibrillation,serum soluble ST2(sST2)levels would increase,and sST2 level was increased with increasing of cardiac function class.When the level of sST2 was higher than 33.20 ng/ml in chronic heart failure patients with atrial fibrillation,its diagnositic sensitivity and specificity were 0.763 and 0.690 respectively.When the level of sST2 was higher than 60.43 ng/ml,the sensitivity and specificity of sST2 for forecasting the risk of short-term(six months)follow-up endpoint events(all-cause mortality and readmission due to heart failure)in chronic heart failure patients with atrial fibrillation were 0.778 and 0.902 respectively.Survival analysis showed that when the level of sST2 was higher than 60.43 ng/ml,the risk of occurring endpoint events in chronic heart failure patients with atrial fibrillation was large,and the survival rate was low.