| Background: Heart failure is the end stage of various heart diseases.With the aging of the population,the incidence of chronic diseases such as hypertension,coronary heart disease,and diabetes has increased,and medical advancements have prolonged the lifespan of patients with cardiovascular disease,leading to the risk of heart failure.The morbidity has continued to rise,and its mortality rate has remained high.The 5-year morbidity rate has reached more than half,and the proportion of hospitalizations for heart failure in the past year has reached 32.8%,which has become the main challenge facing in solving cardiovascular diseases.NT-pro BNP is a widely used biomarker in clinical applications.It has certain value in the screening,diagnosis,differential diagnosis,prognostic evaluation,and cardiovascular event prediction of heart failure.However,due to its susceptibility to age,renal function,BMI,etc.,and the changes in NP levels are difficult to explain with the application of ARNI drugs,more biomarkers are currently needed to guide the treatment and prognosis of heart failure.Soluble ST2 is a new type of biomarker,which is closely related to myocardial fibrosis,ventricular remodeling,inflammation,and oxidative stress.A large number of studies have proved that it has a good predictive effect on the prognosis assessment and risk stratification of heart failure.However,there are few studies on the combination of two indicators to predict the rate of rehospitalization and mortality in patients with heart failure,and there is currently no clear defined value to guide the clinical prediction of the possibility of recurring cardiovascular risk events in patients with heart failure intervene in a timely manner.At present,a large number of clinical experiments and long-term follow-up are still needed to further explore the threshold of ST2,so that it can be better applied in the clinic and guide clinical treatment decisions.Objective: The purpose of this study is to investigate the predictive value of the combined application of soluble ST2 and NT-pro BNP on the rate of rehospitalization and mortality in patients with heart failure.The follow-up of heart failure patients further estimated the soluble ST2 threshold that may be applicable to predict the risk of recurrent cardiovascular adverse events in patients with heart failure.For clinical reference.Methods: Patients with heart failure who were admitted to the Heart Center ofShiyan People’s Hospital from December 1,2018 to June 30,2019.A total of 167 cases were used as the experimental group,and a total of 59 non-heart failure patients hospitalized for other heart diseases during the same period were collected as the control group.Patients with heart failure were classified according to the heart function classification criteria for NYHA.The patients with heart failure were further subdivided into heart function class I(23 cases),II(36 cases),III(59 cases)and IV(49 cases).After obtaining the patient’s informed consent,the patient’s blood samples were centrifuged and stored in a-80℃ refrigerator.After the samples were collected,the values of soluble ST2 and NT-pro BNP were measured uniformly.Collect basic information and related examination results(laboratory tests and cardiac ultrasound)of each group of personnel,and follow-up of discharged patients monthly.All data were analyzed using statistical software SPSS 22.0.Results: 1.Compared with the control group,the levels of serum NT-pro BNP and soluble ST2 in patients with heart failure group were significantly increased(P <0.05).2.With the decrease of cardiac function,the grade of cardiac function increased,the levels of serum NT-pro BNP and soluble ST2 gradually increased,the left atrium of the patient gradually increased,and the left ventricular ejection fraction gradually decreased.Significance(P <0.05).3.Correlation analysis showed that there was a good correlation between soluble ST2 and NT-pro BNP(r=0.562),which was positively correlated.Soluble ST2 was positively correlated with left atrial size(LAD)(r=0.408)and negatively correlated with left ventricular ejection fraction(LVEF)(r=0.439),P <0.05.4.NT-pro BNP,soluble ST2 levels and the combined application of the two indicators for ROC curve diagnosis of heart failure are 0.863,0.735,and 0.866.5.NT-pro BNP,soluble ST2 and the combined application of the two indicators to predict the area under the ROC curve of readmitted heart failure patients within half a year were 0.765,0.771,0.791,the sensitivity was 80.7%,70.5%,81.8%,specificity was 71%,78.3%,73.2%,respectively.The optimal thresholds for NT-pro BNP and soluble ST2 to predict HF rehospitalization within six months were 644pg/ml and 32.265ng/ml,respectively.6.NT-pro BNP,soluble ST2 and two indicators combined application to predict the ROC curve area of death in heart failure patients within half a year is 0.788,0.85,0.805,sensitivity is 95.2%,81%,95.2%,specificity is 60%,77.6%,63.4%.The optimal thresholds for NT-pro BNP and soluble ST2 to predict HF death within half a year were 900.1pg/ml and 40.875ng/ml,respectively.7.Serum NT-pro BNP and solubleST2 levels in patients with cardiovascular events(rehospitalization or death)were significantly higher than those without cardiovascular events(HF patients with stable cardiac function),and the differences were statistically significant(P <0.05).8.Survival analysis showed that the survival rate of patients with NT-pro BNP and soluble ST2 above the optimal threshold level was significantly lower than that of patients below the optimal threshold level.9.COX regression analysis showed that NT-pro BNP and soluble ST2 were risk factors for death in HF patients.After adjusting for confounding factors,soluble ST2 was an independent risk factor for death in HF patients.Conclusions: 1.The level of soluble ST2 increased in patients with heart failure,and gradually increased with the classification of cardiac function,which had a good correlation with left atrial size,left ventricular ejection fraction,and NT-pro BNP.It can be used to evaluate the heart function of patients with heart failure,and it is a beneficial supplement to NT-pro BNP.2.Soluble ST2 can be used for the diagnosis,prognosis and risk stratification of patients with heart failure.It is not as valuable as NT-pro BNP in diagnosis,but it is superior to NT-pro BNP in short-term prognosis and risk stratification.It is an independent risk factor for the death of patients with heart failure.The combined application of the two can improve the diagnosis,prognosis assessment and risk stratification of patients with heart failure.3.When the soluble ST2 is higher than32.265 ng / ml,it indicates that the risk of rehospitalization for HF patients is short-term.When the soluble ST2 is higher than 40.875 ng / ml,it indicates that patients with HF have a higher risk of death in the short term. |
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