Inflammation is one of the principal triggering mechanisms for left ventricular fibrosis and remodeling in heart failure, leading to adverse clinical outcomes. Soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, is assumed to play a significant role in the fibrotic response to inflammation. Left ventricular mass index (LVMI) is a parameter of the prefibrotic inflammatory phase of heart failure preceding remodeling. The present study aimed to investigate the prognostic value of the sST2/LVMI ratio in heart failure with reduced ejection fraction. This was a prospective cohort study. A total of 45 consecutive patients with heart failure with reduced ejection fraction, treated between September 2015 and December 2016, were enrolled. The sST2/LVMI ratio was measured at baseline. The primary endpoint was a composite of cardiovascular mortality and readmission for heart failure. The prognostic impact of the sST2/LVMI ratio was evaluated using a multivariable Cox proportional hazards regression model. Forty-five patients were enrolled in this study. Their average age was 48 ± 14 years, and approximately 20% of them were men. Patients were followed for 9 months, during which the primary outcome occurred in 15 patients. Kaplan–Meier analysis showed that patients with a high sST2/LVMI ratio (≥ 0.39) had shorter event-free survival than those with intermediate (between 0.39 and 0.24) and low ratios (< 0.24) (log-rank, P = 0.022). The fully adjusted multivariable Cox regression analysis showed that the sST2/LVMI ratio was positively associated with the composite outcome in patients with heart failure with reduced ejection fraction after adjusting for confounders (hazard ratio 1.64, 95% confidence interval 1.06 to 2.54). By subgroup analysis, a stronger association was found with age between 40 and 55 years, systolic blood pressure < 115 or ≥ 129 mmHg, diastolic blood pressure < 74 mmHg, hematocrit < 44.5%, and interventricular septum thickness ≥ 8.5 mm. In patients with heart failure with reduced ejection fraction, the relationship between the sST2/LVMI ratio and the composite outcome was linear. A higher baseline ratio of sST2/LVMI was associated with an increased risk of cardiovascular mortality and heart failure rehospitalization in the short-term follow-up.

中文翻译：

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在射血分数降低的心力衰竭患者中，sST2/LVMI 预测心血管死亡率和心力衰竭再住院率的增加：一项前瞻性队列研究

炎症是心力衰竭左心室纤维化和重塑的主要触发机制之一，导致不良的临床结果。可溶性抑制致瘤性 2 (sST2) 是白细胞介素 1 受体家族的成员，被认为在对炎症的纤维化反应中起重要作用。左心室质量指数 (LVMI) 是重构前心力衰竭的纤维化前炎症阶段的参数。本研究旨在探讨 sST2/LVMI 比值对射血分数降低的心力衰竭的预后价值。这是一项前瞻性队列研究。总共有 45 名射血分数降低的心力衰竭患者在 2015 年 9 月至 2016 年 12 月期间接受治疗。在基线测量 sST2/LVMI 比率。主要终点是心血管死亡率和心力衰竭再入院的复合终点。使用多变量 Cox 比例风险回归模型评估 sST2/LVMI 比率的预后影响。45 名患者参加了这项研究。他们的平均年龄为 48 ± 14 岁，其中大约 20% 是男性。对患者进行了 9 个月的随访，在此期间，15 名患者出现了主要结局。Kaplan-Meier 分析显示，sST2/LVMI 比率高（≥ 0.39）的患者比中间（0.39 至 0.24）和低比率（< 0.24）（对数秩，P = 0.022）患者的无事件生存期更短. 完全调整后的多变量 Cox 回归分析显示，sST2/LVMI 比值与调整混杂因素后射血分数降低的心力衰竭患者的复合结局呈正相关（风险比 1.64，95% 置信区间 1.06 至 2.54）。通过亚组分析，发现年龄在 40 至 55 岁之间、收缩压 < 115 或 ≥ 129 mmHg、舒张压 < 74 mmHg、血细胞比容 < 44.5% 和室间隔厚度 ≥ 8.5 mm 之间的相关性更强。在射血分数降低的心力衰竭患者中，sST2/LVMI 比值与复合结果之间呈线性关系。在短期随访中，较高的 sST2/LVMI 基线比率与心血管死亡和心力衰竭再住院风险增加有关。