| Objective:Heart failure(HF)is the end stage of various heart diseases,whose mortality is comparable to that of cancer.In recent years,it has been found that the new marker sST2 helps to predict cardiovascular adverse events in patients with HF,but the systematic comparison of traditional risk factors and new markers in the prognosis evaluation of chronic HF patients is rare.The purpose of this study was to investigate the relationship between the new biomarker sST2 and traditional risk factors for HF,and whether sST2 has an advantage over traditional risk factors in the assessment of HF prognosis.Method:90 patients with chronic HF who were hospitalized in the Department of Cardiovascular Medicine of the Second Hospital of Jilin University from November2018 to June 2019 were randomly selected.(Cases include 55 male patients and 35 female patients.According to NYHA classification there are 30 cases of Grade II,25 cases of Grade III and 35 cases of Grade IV).The underlying causes of HF include ischemic heart disease,cardiomyopathy,heart valve disease,and noncompaction of ventricular myocardium.The diagnostic criteria of HF are based on the Chinese Heart Failure Diagnosis and Treatment Guideline 2018.Another 20 patients(12 males and 8females)who were hospitalized in our hospital for ischemic heart disease,hypertension,arrhythmia and other diseases were selected as the control group,and were excluded from heart failure through cardiac ultrasound and amino-terminal B-type natriuretic peptide precursor(NT-proBNP)tests.All patients received conventional therapy after admission,and were tested for high-sensitivity C-reactive protein(hs-CRP),blood homocysteine(Hcy),left ventricular mass index(LVMI),NT-proBNP,and high-sensitivity troponin I.(Hs-cTnI),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and other traditional risk factors of HF,together with general laboratory tests such as liver function,kidney function,blood glucose and blood lipids.Serum sST2 levels were measured by enzyme-linked immunosorbent assay(ELISA).All patients with HF were followed up for six months after being discharged from the hospital by telephone or outpatient.Adverse events were defined as re-admission due to HF exacerbation and cardiogenic death.Patients with HF were divided into adverse event group(group A)and non-adverse event group(group N)according to whether adverse events occurred;patients with HF were divided into low sST2 and High BB group(group H1),low sST2 and low BB group(group H2),high sST2 and high BB group(group H3),high sST2 and low BB group(group H4)according to the sST2 threshold and the maximum ?-blocker(BB)dose.The general data of selected patients were compared,and the correlation between traditional risk factors(such as NT-proBNP,LVMI,Hcy,LVEF,LVEDD,hs-CRP and hs-cTnI),sST2,and HF prognosis were analyzed.The ROC curve is adopted to evaluate the authenticity of the method.The area under the ROC curve is between 0.5 and 1.0.The closer the value is to 1.0,the higher the authenticity.The closer the value is to 0.5,the lower the authenticity.The threshold is determined by the Jordan index,which is the sum of sensitivity and specificity minus1.It indicates the total ability of the method to find real patients and real non-patients.A larger Jordan index value means a greater authenticity and a more effective screening test.Results:1.The levels of sST2,NT-proBNP,LVMI,Hcy,LVEDD,hs-CRP,and hs-cTnI in HF group were higher than those in the control group,and the LVEF levels were lower than those in the control group with significant differences(P<0.05);2.With the increase of levels according to NYHA classification,the levels of sST2,NT-proBNP,LVMI,and Hcy are increasing,and LVEF is decreasing withsignificant differences(P<0.05).The values of hs-CRP,hs-cTnI,and LVEDD also showed an increasing trend,but the difference is not significant(P>0.05);3.Pearson linear analysis showed that sST2 was positively correlated with NT-proBNP,LVMI,Hcy,and LVEDD,and negatively correlated with LVEF,with significant differences(P <0.05);sST2 was not significantly correlated with hs-CRP and hs-cTnI(P>0.05);4.The baseline sST2,NT-proBNP,LVMI,Hcy,and LVEDD levels in the adverse event group were significantly higher than those in the non-adverse event group(P<0.05);the LVEF values were lower than those in the non-adverse event group,and the hs-cTnI and hs-CRP values were higher than Non-adverse event group,but the difference between the groups was not significant(P>0.05);5.The results of the binary logistic regression model showed that sST2 and NT-proBNP were independent risk factors for poor prognosis of heart failure,with OR values of 1.002 and 1.000,respectively;6.The area under the ROC curve of sST2 is 0.744(95% CI: 0.642-0.846,P<0.001),and the area under the ROC curve of NT-proBNP is 0.757(95% CI:0.659-0.854,P <0.001);the best threshold of sST2 in HF prognosis assessment is921.24 pg / ml,and the best threshold of NT-proBNP in HF prognosis assessment is7491.45ng/L;7.Heart failure patients with sST2>921.24 pg/ml and NT-proBNP>7491.45ng/L have an adverse event incidence rate of 83.3%;Heart failure patients with sST2<921.24 pg/ml and NT-proBNP<7491.45ng/L have an adverse event incidence rate of only 4.17%;The incidence rate of adverse events was 51.28% in heart failure patients with sST2>921.24pg/ml and NT-proBNP <7491.45ng/L;The incidence rate of adverse events was 66.67% in heart failure patients with sST2<921.24pg/ml and NT-proBNP>7491.45ng/L.8.The results of the binary logistic regression model showed that the incidence of adverse events in the low sST2 and low BB group(group H2)was not significantly different(P> 0.05)from the low sST2 and high BB group(group H1);Compared withgroup H1,the high sST2 and high BB group(group H3)and the high sST2 and low BB group(group H4)had significantly higher adverse event rates,with OR values of10.500 and 12.765,respectively.Conclusions:1.The expression of sST2 is increased in patients with chronic heart failure,and it is related to traditional risk factors for heart failure;2.Like NT-proBNP,sST2 can be used as an independent risk factor for the risk of adverse events in patients with heart failure.3.The sST2 level combined with the BB dose level can further stratify the chronic HF patients with different risk levels.Heart failure patients with sST2 levels higher than the threshold value can benefit more from high-dose BB treatment. |
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