Head to Head Comparison of Suppression of Tumorogenicity 2 and Copeptin Significance for Prognosis of Patients After Acute Heart Failure Decompensation

Скворцов, А. А.; Protasov, V N; Narusov, O Yu; Koshkina, D. E.; Osmolovskaya, Yu. F.; Kuznetsova, T V; Масенко, В. П.; Терещенко, С. Н.

doi:10.18087/cardio.2017.9.10028

Cited by 6 publications

(6 citation statements)

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“…Наше исследование было посвящено поиску новых возможностей в стратификации риска и оценке про- [26][27][28]. Самую высокую информативность имели концентрации sST2, NT-proBNP и копептина, определенные после достижения компенсации, а также степень снижения уровня sST2 за время пребывания в стационаре (ΔsST2).…”

Section: Discussionunclassified

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Multimarker Approach in Risk Stratification of Patients with Decompensated Heart Failure

et al. 2019

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Purpose: to study prognostic value of various biomarkers and their combinations in patients who survived decompensation of chronic heart failure.Materials and methods.Patients (n=159) who were hospitalized with diagnosis of heart failure (HF) decompensation were included in a prospective single-center study. Examination on admission and the day of hospital discharge, included measurement of concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), copeptin, soluble suppression of tumorigenicity 2 (sST2), kopetin, neutrophil gelatinase-associated lipocalin (NGAL), and galectin-3. Te combined primary endpoint comprised cardiovascular (CV) death, frst hospitalization because of HF heart failure decompensation, episodes of HF deterioration which required additional i/v diuretics, and CV death with successful resuscitation.Results.During one-year follow-up 56 pts (35.2%) reached the combined primary endpoint. Tere were 78 (49.1%) cardiovascular events. During hospitalization, patients with the decompensation of heart failure experienced a decrease of sST2, NT-proBNP, galectin-3, kopetin, hsTnT and an insignifcant increase of NGAL. ROC analysis identifed signifcant relation between concentrations of NT-proBNP, sST2, copeptin and, to a lesser degree, hsTnT, determined at hospital discharge, and risk of combined primary endpoint during 1-year follow-up: area under the curve (AUC) was 0.733 [95% CI 0.645–0.820], p<0.0001, 0.772 [95% CI 0.688–0.856], p<0.0001, 0.735 [95% CI 0.640–0.830], p<0.0001, and 0.659 [95% CI 0.553–0.764], p=0.005, respectively. Patients who during hospitalization did not achieve cut-oﬀ values of NT-proBNP ≤1696 rg/ml, sST2≤37.8 hg/ml, copeptin≤28.31 rmol/L and hsTnT≤28.37 rg/ml, had higher risk of reaching adverse events during 1 year; OR and 95% CI were 2.96 [1.61, 5.42] p<0.0001, 4.31 [2.34, 7.93] p<0.0001, 3.06 [1.59, 5.89] and 2.19 [2.12, 4.27]), respectively. According to Cox regression analysis, risk of the combined primary end point was the highest in patients with 3 or more elevated markers (OR = 6.6 [3.584, 12.158], p<0.0001), average in patients with 2 elevated markers (OR = 1.123 [0.51, 2.48]), p=0.7), and the lowest in patients with no markers increase or increase of only one marker (OR = 0.11 [0.049, 0.241], p<0.0001). In the Kaplan-Mayer survival analysis all three groups were statistically diﬀerent. In order to identify the most prognostically strong model, a reclassifcation analysis was performed. According to this analysis, the combination of sST2 and NT-proBNP concentrations determined at hospital discharge, exceeded one NT-proBNP (reclassifcation = –8.1%). At the same time, predictive value of only sST2 just insignifcantly less than value of sST2 and NT-proBNP combination (reclassifcation = –1.9%).Conclusion.Patients with three and more elevated markers at hospital discharge have high risk of adverse events. Te biggest prognostic value has combination of sST2 and NT-proBNP concentrations. In order to determine the long-term prognosis of a patient with HF decompensation, it is sufcient to measure concentrations of sST2 and NT-proBNP at hospital discharge. Alternatively, it is possible to limit to sST2 only, which is just insignifcantly inferior to the sST2 and NT-proBNP combination. Patients with concentrations of sST2 ≥37.8 hg/ml and NT-proBNP ≥1696 rg/ml at hospital discharge have maximal 1year risk of death due to recurrent HF decompensation.

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Section: Discussionunclassified

“…ВчТрТ уступал перечисленным трем маркерам в отношении прогнозирования наступления ККТ. Подробно анализ этих данных был нами изложен ранее [26][27][28].…”

Section: оценка прогностической значимости маркеровunclassified

Multimarker Approach in Risk Stratification of Patients with Decompensated Heart Failure

et al. 2019

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“…Полученные нами данные в значительной степени дополняют и объясняют более ранние наши и зарубежные публикации и исследования, которые показали, что именно эти три биомаркера имеют важнейшее значение в стратификации риска и определении прогноза больных СН [6,[9][10][11][12]. Причем согласно результатам нашего анализа, посвященного прямому сопоставлению возможностей этих трех биомаркеров, оказалось, что по сравнению с копептином и стандартной клинико-биохимической моделью (включающей значения NT-proBNP) sST2 является более сильным предиктором наступления сердечно-сосудистой смерти / госпитализации из-за СН у больных после декомпенсации СН при кратко-(90 дней), средне-(180 дней) и долгосрочном наблюдении [16].…”

Section: Discussionunclassified

“…Как показали результаты нашего протокола, из 6 исследованных новых биомаркеров, помимо NT-proBNP, изменение концентраций копептина и sST2 было наиболее тесно связано с изменением клинического и функционального статуса, качества жизни, а также наиболее важных ЭхоКГ параметров больных СН при длительном наблюдении и лечении. Учитывая данные ранее проведенных клинических исследований, а также результаты наших работ, показавших превосходство sST2 над копептином при их прямом сопоставлении при оценке риска больных СН после перенесенной ОДСН [16,29], наибольшего внимания заслуживал анализ возможности использования растворимого ST2 рецептора также и для контроля эффективности проводимого лечения. Целесообразность такого выбора обусловлена и тем, что sST2 не только не уступал, но и несколько превосходил NT-proBNP при оценке прогноза больных СН при длительном наблюдении после перенесенной декомпенсации [6].…”

Section: Discussionunclassified

Clinical significance of serial biomarkers activity determination after acute heart failure decompensation: sST2 NT-proBNP role during long-term follow-up

et al. 2018

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Aim. Monitoring of concentrations of modern biomarkers to evaluate the efficacy of long‑term treatment of patients after acute decompensated HF (ADHF).Materials and Methods. The study included 100 patients with severe decompensated FC II–IV CHF and LV EF <40 % due to IHD, DCMP or AH. At discharge from the hospital, patients were divided into groups of low (NT‑proBNP<1400 pg / ml) (control, n=30) and high (NT‑proBNP≥1400 pg / ml) risk (n=70). Patients at high risk were randomized to two treatment groups, a group of NT‑proBNP monitoring (NPM) (n=35) and a group of standard therapy (n=35). At the end of the study, noncompliant patients were isolated from these two groups into a separate group (n=10). The aim of the treatment was decreasing the NT‑proBNP concentration to less than 1000 pg / ml and / or ≥50 % of the baseline level. In addition to the soluble suppression of tumorigenicity 2 (sST2) receptor, concentrations of copeptin, neutrophil gelatinase associated lipocalin (NCAL), galectin 3, and high‑sensitivity troponin T were measured at discharge from the hospital (baseline) and at three and 6 months of treatment.Results. The strongest correlations were found between changes in concentrations (Δ%) of NT‑proBNP, copeptin, and sST2 and changes in CHF FC, 6‑min walk distance, CCS, quality of life, LV EF, and Е / Е’ (р<0.001). The incidence of cardiovascular events was directly related with the degree of decrease and / or increase in biomarker concentration. Patients of the NPM group had the lowest risk of adverse clinical outcome upon a decrease in NT‑proBNP <988.5 pg / ml at 6 months of treatment or > 50 % of the baseline level at discharge from the hospital. For these patients, the mean Δ% was 60.7±8.5 % for NT‑proBNP, 34.03±17.6 % for sST2, and 32.41±8.8 % for copeptin [OR at 95 % CI 0.08 (0.02–0.36), р <0.0001]. A significant increase in the risk for cardiovascular events was observed only at a considerable increase in NT‑proBNP >50 % [OR at 95 % CI 3.8 (1.13–13.0), р=0.03], and the highest incidence of cardiovascular events was observed in the group of noncompliant patients (110 %). Besides NT‑proBNP, to significantly decrease the risk of cardiovascular events, it was necessary to achieve a decrease in sST2 concentration to less than 30 ng / ml or by more than 24.9 % (Δ%) at the end of followup [ОR (95 % CI: 0.1 (0.02–0.5), р=0.004].Conclusion. Among the modern biomarkers, changes in NT‑proBNP, sST2, and copeptin concentrations most accurately reflect changes in the clinical and functional status, quality of life, and EchoCG parameters in HF patients during long‑term monitoring. The lowest risk for adverse clinical outcomes was observed in post‑decompensation patients with a decrease in NT‑proBNP <988.5 pg / ml after 6 months of treatment or ≥50 % of baseline upon discharge from the hospital. The sST2 concentration has to be reduced by more than 24.9 % of baseline and less than 30 ng / ml in the course of long‑term treatment after decompensated HF.

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“…Весомый вклад в изучение вопросов клинической значимости серийного тестирования sST2 вносят и российские исследователи, разноплановые работы которых, в целом поддерживают данную стратегию. При этом внимания заслуживают аспекты явного преимущества sST2 по сравнению, в частности, с копептином при использовании новых биомаркеров СН (в дополнение к NT-proBNP) в долгосрочных прогностических моделях [52]; необходимость снижения уровня sST2 (<30 нг / мл или ≥25 % от исходного) для улучшения прогноза [53]; целесообразность использования мультимаркерной панели [54]. И, наконец, очень небольшая, но перспективная серия наблюдений (n =35), где было продемонстрировано, что определение содержания sST2 в крови до и после теста 6-минутной ходьбы позволяет повысить специфичность и чувствительность метода стратификации риска развития неблагоприятных сердечно-сосудистых событий (86,7 и 85,0 % соответственно; AUC=0,86, р<0,0001) [55].…”

Section: Cерийное тестирование Sst2 и прогноз при хронической сердечнunclassified

Soluble ST2 – as a biomarker, a tool for risk stratification and therapeutic target in patients with chronic heart failure

et al. 2020

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This review focuses on possibilities of using soluble ST2 as a HF marker for diagnostics, stratification of risk of adverse events, and for evaluation of prognosis and treatment effectiveness in patients with CHF. Circulating biomarkers are an essential element of algorithms for diagnostics, stratification of risk, and evaluation of prognosis in patients with HF. The recognized “gold standard”, natriuretic peptides, has several well-known limitations, and multiple new candidate biomarkers have appeared in recent years. Soluble ST2, a marker of “mechanical myocardial stress”, is considered as one of the most promising new biomarkers. This review discusses possibilities of using it in clinical practice in CHF patients.

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Head to Head Comparison of Suppression of Tumorogenicity 2 and Copeptin Significance for Prognosis of Patients After Acute Heart Failure Decompensation

Cited by 6 publications

References 37 publications

Multimarker Approach in Risk Stratification of Patients with Decompensated Heart Failure

Multimarker Approach in Risk Stratification of Patients with Decompensated Heart Failure

Clinical significance of serial biomarkers activity determination after acute heart failure decompensation: sST2 NT-proBNP role during long-term follow-up

Soluble ST2 – as a biomarker, a tool for risk stratification and therapeutic target in patients with chronic heart failure

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