| Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je ispitati vrijednost solubilnog ST2 u bolesnika s akutnim pogoršanjem kroničnog srčanog zatajivanja i ispitati razlike u kliničkim i laboratorijskim pokazateljima tih bolesnika s obzirom na vrijednost sST2.
Materijali i metode: Ovo istraživanje uključuje ukupno 60 bolesnika sa znakovima pogoršanja srčanog zatajenja, a koji su bili na bolničkom liječenju na Klinici za bolesti srca i krvnih žila KBC-a Split u vremenskom periodu od listopada 2018. do veljače 2019. godine. Istraživanje je odobreno od strane Etičkog povjerenstva KBC-a Split i Etičkog povjerenstva Medicinskog fakulteta u Splitu, a potpisani informirani pristanak je uzet od svih uključenih bolesnika. Svim bolesnicima je uzeta detaljna anamneza, obavljen detaljan klinički pregled i široka laboratorijska analiza. ELISA metoda (engl. enzyme-linked immunosorbent assay) se koristila za određivanje serumskih koncentracija sST2 (Phoenix Pharmaceuticals Inc., Burlingame, SAD) prema uputama proizvođača.
Rezultati: Najveći broj bolesnika imao je srčano zatajivanje s reduciranom ejekcijskom frakcijom lijevog ventrikula (N=27; 45,0%) i klasificiran je kao NYHA stupanj 3 (N=44; 73,3%). Najčešći komorbiditeti bolesnika su hipertenzija (N=56; 93,3%), dislipidemija (N=48; 80,0%) i fibrilacija atrija (N=35; 58,3%). Nije utvrđena statistički značajna razlika u vrijednostima sST2 s obzirom na klinički fenotip očuvanosti ejekcijske frakcije (P=0,498). Statistički značajne razlike su imali bolesnici u procijenjenoj brzini glomerularne filtracije pa su bolesnici s višim razinama sST2 imali nižu procijenjenu brzinu (47,8 ± 27,1 vs. 61,8 ± 21,3 mL/min/1,73m^2; P=0,030). U bolesnika s obzirom na razinu sST2 nije bilo razlike u dobi (71,3 ± 8,5 vs. 71,5 ± 7,6 godina; P=0,937). Bolesnici s višom razinom sST2 imali su statistički značajno viši NYHA stupanj srčanog zatajivanja od onih s nižom razinom sST2 (3,3 (2,7-3,9) vs. 2,7 (2,2-3,3); P<0,001). Bolesnici s razinom serumske koncentracije sST2 iznad 35 ng/mL imali su statistički značajne niže serumske razine željeza u odnosu na bolesnike s nižom razinom sST2 (10,3 ± 5,14 vs. 13,7 ± 7,01 μmol/L; P=0,038).
Zaključci: Bolesnici s višom serumskom razinom sST2 su imali više serumske razine NT-proBNP i kreatinina, češće kao komorbiditet su imali šećernu bolest te su imali nižu serumsku razinu željeza, niži NYHA stupanj zatajivanja srca i manju procijenjenu brzinu glomerularne filtracije. Nije pronađena razlika u vrijednostima sST2 s obzirom na tip zatajenja srca u odnosu na ejekcijsku frakciju. Potrebna su daljnja istraživanja na većem broju bolesnika kako bi se dodatno istražila uloga sST2 u bolesnika sa srčanim zatajivanjem. |
| Abstract (english) | Aim: The aim of this research was to question the level of soluble ST2 in patients with acute worsening of chronic heart failure and to question differences in clinical and laboratory indicators of those patients considering the level of soluble ST2.
Materials and methods: This study includes a total of 60 patients with signs of worsening heart failure who were hospitalized at Department of Cardiology, University Hospital of Split in period from October 2018 until February 2019. The research was approved by Ethics committee of University Hospital of Split and Ethics committee of University of Split School of Medicine, and the signed informed consent was taken from all patients who were included. Detailed anamnesis, full clinical examination and extensive laboratory analysis were made on all patients. ELISA method (enzyme-linked immunosorbent assay) was used to determine serum level of sST2 (Phoenix Pharmaceuticals Inc., Burlingame, USA) according to manufacture instructions.
Results: The highest number of patients had heart failure with reduced left ventricular ejection fraction (N=27; 45.0 %) classified as NYHA stage 3 (N=44: 73.3%). The most common comorbidities of the subjects were hypertension (N=56; 93.3%), dyslipidemia (N=48; 80.0%) and atrial fibrillation (N=35; 58.3%). No statistically significant difference in sST2 values was found according to clinical phenotype of ejection fraction preservation. Statistically significant differences were present in estimated glomerular filtration rate, so the patients with higher levels of sST2 had lower estimated rate (47.8 ± 27.1 vs. 61.8 ± 21.3 mL/min/1.73m^2; P=0.030). Considering the level of sST2, there was no age difference of included patients (71.3 ± 8.5 vs. 71.5 ± 7.6 years; P=0.937). Patients with higher level of sST2 had statistically higher NYHA stage of heart failure than those with lower level of sST2 (3.3 (2.7-3.9) vs. 2.7 (2.2-3.3); P<0.001). Patients with serum concentration sST2 level higher than 35 ng/ml had statistically lower serum iron level in contrast to patients with lower sST2 level (10.3 ± 5.14 vs. 13.7 ± 7.01 μmol/L; P=0.038).
Conclusion: Patients with higher sST2 serum level have higher serum level of NT-proBNP and creatinine, more often they had diabetes and lower serum iron level as comorbidity, lower NYHA stage of heart failure and lower estimated glomerular filtration rate. No difference was found in sST2 levels considering the heart failure type in regards to ejection fraction. Further research is needed on a larger number of subjects to additionally investigate the role of sST2 in patients with heart failure. |
