Head- to- Head Comparison of 2 Myocardial Fibrosis Biomarkers for Long-Term Heart Failure Risk Stratification
Head- to- Head Comparison of 2 Myocardial Fibrosis Biomarkers for Long-Term Heart Failure Risk Stratification
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DOI：
10.1016/j.jacc.2013.07.087
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发表时间：
2014-01-21
影响因子：
24
通讯作者：
Lupon, Josep
中科院分区：
文献类型：
--
作者：
Bayes-Genis, Antoni;de Antonio, Marta;Lupon, Josep
目的比较ST2和Galectin-3(Gal-3)在动态心力衰竭(HF)人群中的长期危险分层和其他危险因素，包括N末端B型利钠肽。背景ST2和Gal-3是有前景的心肌纤维化和重塑的生物标志物。在区分、校准和重新分类分析方面，这两个生物标志物相对于传统评估(11个危险因素)加N末端前B型利钠肽进行了评估。终点是5年全因和心血管死亡率，以及全因死亡/心衰住院。结果在中位数4.2年的随访期(存活患者为5.9年)，392名患者死亡。在双变量分析中，Gal-3和ST2是所有终点的自变量。在多变量分析中，只有ST_2与心血管死亡率独立相关(危险比：1.27，95%可信区间：1.05-1.53，p=0.014)。将ST2纳入全因死亡率(包括临床变量和N末端前B型利钠肽)的全校正模型中，提高了区分度(C统计量：0.77，p=0.004)和校正，并显著改善了重新分类(综合区分度改善：1.5，95%可信区间：0.5至2.5，p=0.003；净重分类指数：9.4，95%可信区间：4.8至14.1p<；0.001)。加入Gal-3没有明显增加辨别或重新分类以及更差的校准指标。在直接模型比较上，ST2优于Gal-3。结论慢性心力衰竭患者肝纤维化标志物ST2和Gal-3的直接比较显示，在危险分层方面，ST2优于Gal-3。Gal-3对现有临床危险因素的增量预测贡献微不足道。(C)2014年，由美国心脏病学院基金会
Objectives ST2 and galectin-3 (Gal-3) were compared head-to-head for long-term risk stratification in an ambulatory heart failure (HF) population on top of other risk factors including N-terminal pro-B-type natriuretic peptide.Background ST2 and Gal-3 are promising biomarkers of myocardial fibrosis and remodeling in HF.Methods This cohort study included 876 patients (median age: 70 years, median left ventricular ejection fraction: 34%). The 2 biomarkers were evaluated relative to conventional assessment (11 risk factors) plus N-terminal pro-B-type natriuretic peptide in terms of discrimination, calibration, and reclassification analysis. Endpoints were 5-year all-cause and cardiovascular mortality, and the combined all-cause death/HF hospitalization.Results During a median follow-up of 4.2 years (5.9 for alive patients), 392 patients died. In bivariate analysis, Gal-3 and ST2 were independent variables for all endpoints. In multivariate analysis, only ST2 remained independently associated with cardiovascular mortality (hazard ratio: 1.27, 95% confidence interval [ CI]: 1.05 to 1.53, p = 0.014). Incorporation of ST2 into a full-adjusted model for all-cause mortality (including clinical variables and N-terminal pro-B-type natriuretic peptide) improved discrimination (C-statistic: 0.77, p = 0.004) and calibration, and reclassified significantly better (integrated discrimination improvement: 1.5, 95% CI: 0.5 to 2.5, p = 0.003; net reclassification index: 9.4, 95% CI: 4.8 to 14.1, p < 0.001). Incorporation of Gal-3 showed no significant increase in discrimination or reclassification and worse calibration metrics. On direct model comparison, ST2 was superior to Gal-3.Conclusions Head-to-head comparison of fibrosis biomarkers ST2 and Gal-3 in chronic HF revealed superiority of ST2 over Gal-3 in risk stratification. The incremental predictive contribution of Gal-3 to existing clinical risk factors was trivial. (C) 2014 by the American College of Cardiology Foundation