| Background:Acute Heart Failure(AHF is the most common severe cardiac emergency in the emergency department.In recent years,some studies abroad found that serum soluble ST2(sST2)in patients with acute heart failure increased significantly.And ST2 was a independent prognostic factor for AHF,to improve risk stratification and to guide the monitoring and treatment.We detected serum ST2 level of patients with AHF,and set up the control group.These AHF patients were followed up for 1 year,and we compared the sST2 level,the NT-proBNP level and other relevant parameters between the event group(readmission because of acute heart failure or all-cause death)and the non-event group.And we also observed the correlation between the AHF severity and the sST2 level,and the correlation between sST2 and other clinical parameters.We hope toexplore the value of sST2 in the evaluation of prognosis for acute heart failure.Methods:We observed the patients whose chief complaints were acute dyspnea admitted to the emergency department from January 2013 to August 2014.75 AHF patients aged 60 to 93 were selected in our study who were in Beijing Hospital during 2013.1?2014.8,including 40 cases of male and 35 cases of female.Moreover,38 healthy people aged 70 to 80 were chosen as control group,which contains 18 cases of male and 20 cases of female.Follow-up was performed 1 year after acute attack.We defined the end of observation as recurrence of heart failure or any causes of death.The data was analyzed by SPSS 19.0.Results:1.The parameters which conformed to the normal distribution include:age,sST2,LVEF,left ventricular end-diastolic diameter,left ventricular end-diastolic volume,systolic blood pressure,serum creatinine,the parameters which didn't conformed to the normal distribution include:NT-proBNP and TNI.2.Compared with control group,sST2 level(pg/ml)was significantly elevated in AHF group(596.9±181.2 vs.1698.9±797.0,P<0.001).No significant difference was found between male and female(1713.1±1322.2 vs.1727.5±867.1,P=0.956).3.sST2 level(pg/ml)was significantly different between patients with different clinical heart function grade[1439.5±694.5(mild-I and?grade)vs.2057.8±1428.6(severe-?and?grade),P=0.026].4.Spearman correlation analysis showed that sST2 was not correlated to left ventricular ejection fraction(LVEF),left ventricular diastolic end diastolic diameter,creatinine,TnI,systolic blood pressure,age or NT-proBNP.And the correlation study showed that the NT-proBNP level was negatively associated with LVEF(r=-0.533,P<0.05),and the NT-proBNP level was positively associated with left ventricular end-diastolic diameter,creatinine.TnI(r=0.303,r=0.612,r=0.296,P<0.05).There was no correlation between age and ST2,neither NT-proBNP.5.Among the 75 AHF patients,sST2 level was higher in patients with endpoint events than those without endpoint events(2234.4±1308.5 vs.1162.3±452.6,P=0.000).6.According to the independent risk factors of unconditioned logistic bivariate regression model analysis,the levels of sST2,NT-proBNP and the clinical heart function Grade had independent predicting value of AHF(OR value were 1.003,1.001 and 7.46 respectively).7.From the receiver operator characteristic curve,We found that the cutoff value of sST2(1760 pg/ml)may be an valuable evaluation marker of prognosis,the sensitivity and specificity was 64%and 92%,and the positive and negtive predictive rate were 89%and 70%.The accuracy rate was 77%.Combined with NT-proBNP to predict the prognosis of AHF,the result would be more exciting.The area under the ROC curve is 0.889,and it is better than sST2 lonely.Conclusions:Early at admission of AHF in elderly patients.sST2 began to elevate markedly related with the extent of heart failure.The result shows that the level of sST2 may be used to evaluate patient.The elevation of sST2 has independent predictive value to the prognosis of AHF.Combined with NT-proBNP to predict the prognosis of AHF,the result would be more prospective. |
PDF Full Text Request