The Level And Clinical Significance Of Soluble ST2 In Heart Failure Patients With Atrial Fibrillation

Objective:The purpose of this study is to determine the level of Soluble Supp ression of Tumorigenicity-2（s ST2）in patientswith heart failure（HF）and atrial fi brillation（AF）,to explore the relationship betweenplasma s ST2 with other clini cal data,and to explore its diagnostic and prognostic value in patients with HF and AF.Methods:A prospective cohort study was carried out to investigate the data of 185HF patients（aged 45 to 94 years,109 Males and 76 females）.who were hospitalized between January 2018 and June 2018 in department of cardiology or department of cardiac care unit in TEDA International Cardiovascular Hospital.And according to whether they had atrial fibrillation before admission,we categorized patients into:HF with sinus rhythm（HF-SR,n=90,aged 45 to 87 years,48 Males and 42 females）and HF with AF（HF-AF,n=95,aged 47 to 94 years,61 Males and 34females）.Meanwhile,40 healthy controls were collected（aged 52 to 76 years,24 Males and 16females）.Baseline data（age,gender,BMI,NYHA grade of cardiac function,Medical history）of HF-SR and HF-AF groups and plasma s ST2 levels in different ejection fraction groups were compared.Plasma s ST2 level was determined by enzyme-linked immunosorbent assay（ELISA）.Statistical methods such as nonparametric test and Spearman correlation analysis were used.The receiver operating characteristic curve was applied to evaluate the diagnostic value of s ST2 in HF-SR and HF-AF groups.And by using the COX risk model,Multi-factor COX analysis was used to analyze the prognosis of patients.The follow-up period was 6 months.The end point of follow-up was readmission of heart failure or cardiovascular death.Results:1.There was no significant difference between HF-SR and HF-AF gro up in gender,age,BMI and other indicators.There was no significant differen ce between HF-SR and HF-AF group in systolic blood pressure,diastolic blo od pressure,smoking history,drinking history,valvular disease,cardiac function grade,LVEF,e GFR.There were significant differences in left ventricular diame ter LV-D,left atrium diameter（LA-D）,ALT,γ-GT,WBC number and BNP bet ween the two groups（P<0.05）.2.Compared with healthy controls,the me-dian(P₂₅,P₇₅)of Plasma s ST2 levels in HF patients increased remarkably[32.93（20.31～51.39）ng/m L vs[15.99（7.97～22.69）]ng/m L,Z=-4.373,P<0.001].Patients with HF-AF group had significantly higher test results[39.86（27.20～59.21）]n g/m L than HF-SR group[24.74（14.83～44.11）]ng/m L,Z=-6.783,P<0.001).In th e HFmr EF and HFp EF subgroups,the plasma s ST2 level of patients in the HF-AF group was higher than that in the HF-SR group（Z=-2.381,P=0.016.Z=-3.701,P<0.001）.Spearman correlation analysis showed that,in HF-AF patients,pla sma s ST2 level was positively correlated with diastolic blood pressure,Hyperte nsion,New York Association（NYHA）cardiac function classification III to IV,white blood count（WBC）,and the level of Alanine Aminotransferase（ALT）,γ-glutamine transaminase（γ-GT）,B-type natriuretic peptide（BNP）（r>0,P<0.05）.Al so,there is a negative correlation between s ST2,left ventricular ejection fracti on（LVEF）and estimated Glomerular Filtration Rate（e GFR）（r<0,P<0.05）.At ROC analysis,s ST2 showed predictive value in both HF-AF and HF-SR grou p,with an optimal cut-off value of 25.33 ng/m L（AUC 0.872,95%CI:0.805-0.935,P<0.001,sensitivity 81.1%,specificity 87.5%,PPV=87.15%,NPV=88.89%）and 23.34 ng/m L（AUC 0.665,95%CI:0.570-0.761,P<0.001,sensitivity 55.6%,specificity 77.5%,PPV=70.31%,NPV=86.96%）.The AUC of BNP and s ST2 in differential diagnosis of HF-SR and HF-AF was 0.604 and 0.699,respectively,and the AUC of s ST2 was higher than that of BNP.Multi-factor COX analysi sindicated that plasma s ST2 level,BNP,NYHA cardiac function grading could be risk factors for cardiac events in HF patients.Plasma s ST2,left atrial diam eter（LA-D）,and associated cardiomyopathy are risk factors for cardiac events in patients with HF-AF.The incidence of cardiac events in HF patients with s ST2≥20.31ng/m L was significantly higher than that of patients with s ST2<20.31ng/m L（χ²=7.625,P=0.006）.The incidence of cardiac events in HF-AF patient s with plasma s ST2≥39.86 ng/m L was significantly higher than that in patients with s ST2<39.86ng/m L（χ²=4.287,P=0.038）.Conclusions:The plasma s ST2 level in patients with HF-AF is significantly higher than that both in HF-SR and healthy controls.The diagnostic value of plasma s ST2 in patients with HF-AF is higher than that in patients with HF-SR.It is suggested that s ST2 are more valuable for the differential diagnosis of HF-SR,HF-AF than BNP.HF-AF Patients with plasma s ST2≥39.86 ng/m L are prone to cardiovascular events.