医学
危险系数
心力衰竭
比例危险模型
内科学
利尿剂
心脏病学
醛固酮
促炎细胞因子
生物标志物
炎症
置信区间
生物化学
化学
作者
Tobias Breidthardt,Cathrin Balmelli,Raphael Twerenbold,Tamina Mosimann,Jaqueline Espinola,Philip Haaf,Gregor Thalmann,Berit Moehring,Mira Mueller,B. Meller,Tobias Reichlin,Karsten Murray,Ronny Ziller,Pascal Benkert,Stefan Osswald,Christian Mueller
标识
DOI:10.1016/j.cardfail.2013.11.003
摘要
Biomarkers may help to monitor and tailor treatment in patients with acute heart failure (AHF).Levels of ST2, a novel biomarker integrating hypervolemic cardiac strain and proinflammatory signals, were measured at presentation to the emergency department (ED) and after 48 hours in 207 patients with AHF. Patients were stratified according to their early ST2 response (responders: ST2 decrease ≥25%; nonresponders: ST2 decrease <25%) and beta-blocker, renin-angiotensin-aldosterone system (RAAS) blockade, or diuretic treatment status at hospital discharge. We assessed the utility of ST2 levels and its changes to predict long-term mortality and the interaction between ST2 levels, treatment at discharge, and 1-year mortality. ST2 levels were higher in nonsurvivors than in survivors (median 108 vs 69 ng/mL; P < .01) and decreased significantly during the 1st 48 hours (median decrease 33%). ST2 decrease was less in nonsurvivors compared with survivors (median -25% vs -42%; P < .01). In Cox regression, early ST2 changes independently predicted 1-year mortality (hazard ratio 1.07 for every increase of 10%; P = .02). RAAS blockers at discharge were associated with survival independently from ST2 response, whereas the association of beta-blockers with survival differed markedly according to ST2 response, with beneficial effects restricted to ST2 nonresponders (P interaction = .04). A similar, albeit nonsignificant, trend was observed for diuretics (P interaction = .11).ED and serial ST2 measurements are independent predictors of 1-year mortality in AHF.
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