Clinical Value Of Serum Soluble ST2 In Diagnosis,Heart Function Classification And Prognosis Of Chronic Heart Failure

Objective:To determine the serum soluble ST2 level in patients with chronic heart failure and explore its clinical value in the diagnosis,heart function classification and prognosis of heart failure.Methods: A total of 359 patients with chronic heart failure(CHF)diagnosed and hospitalized in Department of Cardiology,the Second Hospital of Tianjin Medical University and Naval Logistics College Hospital from September 2015 to December 2016 were enrolled as CHF group.The patients were divided into three subgroups: grade?(54 cases),grade?(137 cases)and grade?(168 cases)with NYHA heart functional classification.Another 110 non-CHF patients admitted to our hospital during the same period were enrolled as control group.All patients were admitted to the hospital acceptted fasting elbow venous blood samples collectionon in the second morning,then many indicators of the blood samples such as soluble ST2,BNP,NT-pro BNP,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-c),Fasting blood glucose(FBG),Hb A1 c,Ccr and BUN and so on were measured.The SBP and DBP were measured by Omron electronic sphygmomanometer.Left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured by echocardiography.General clinical data on age,body mass index(BMI),diabetes and hypertension,hyperlipidemia and other cardiovascular diseases are recorded in detail.The fasting venous blood was collected again from the CHF group one day before discharge to measure the levels of soluble ST2,BNP and NT-pro BNP.The incidence of cardiovascular events was observed one year after the discharge.Cardiovascular events were defined as cardiogenic death and rehospitalization due to heart failure.If CHF patients within 1 year after discharge undergo cardiovascular events,then assigned to the cardiovascular event group and the follow-up is stopped.If CHF patients 1 year after discharge without cardiovascular events,then divided into no cardiovascular events group.To investigate the association between serum soluble ST2 and CHF related indicators,and the predictive value of serum soluble ST2 at discharge on the occurrence of cardiovascular events in CHF patients within 1 year after discharge from hospital.Results: 1.The level of serum soluble ST2 in CHF patients on admission was significantly higher than that of the control group(P <0.05).2.The level of serum soluble ST2 in CHF patients on admission increased gradually with the increase of NYHA functional class.3.Pearson's linear correlation analysis showed that the level of serum soluble ST2 in patients with CHF at admission was significantly and positively correlated with BNP,NT-pro BNP and LVEDD,and negatively correlated with LVEF.4.There was no correlation between serum soluble ST2 level and the etiology of chronic heart failure(P> 0.05).5.Covariance analysis data showed differences in sST2 levels at different levels of cardiac function,but the interaction showed P> 0.05,indicating that there was no interaction between age,BMI,and renal and cardiac function.6.At the end of follow-up,the levels of sST2,BNP,NT-pro BNP,LVEDD and LVEF in cardiovascular events were significantly higher than those without cardiovascular events(P <0.05).7.Multivariate Cox stepwise regression analysis showed that five factors,such as age more than 65 years,cardiac function classification,serum sST2 levels,NT-pro BNP and BNP levels were independent risk factors for prognosis in CHF patients(P <0.05).8.ROC curve analysis found that the area under the ROC curve of sST2 was 0.792,the area under the ROC curve of BNP was 0.750,and the area under the ROC curve of NT-pro BNP was 0.777.In addition,the area under the ROC curve for the combination of sST2 and BNP was 0.809,and the area under the ROC curve for the combination of sST2 and NT-pro BNP was 0.823.Maximum sensitivity and specificity were achieved at a sST2 concentration of 45.6 ng /ml(sensitivity = 78.9,specificity = 90.4).Conclusion:(1)Serum sST2 can be used as a new biochemical marker in the diagnosis of heart failure.(2)Serum soluble ST2 can be used as a new biochemical marker to reflect the severity of heart failure.(3)The level of serum soluble ST2 can help to judge the prognosis of chronic heart failure,which may provide some help for clinical work.(4)Serum soluble ST2 was not affected by patient's age,body mass index and renal function.