Abstract
Objective To explore the correlation between levels of serum lipoprotein-associated phospholipase A2 (LP-PLA2) and soluble suppression of tumorigenicity 2 (sST2) and condition of acute heart failure (AHF) patients and their predictive value for prognosis. Methods The data of patients who complained of acute dyspnea and were treated in our hospital (January 2018–January 2020) were selected for review analysis, and those diagnosed with AHF by means of chest films, physical examination, cardiogram, and color Doppler ultrasonography (CDS) were selected as the study objects. The patients were split into the mild group (I or II, 55 cases) and the severe group (III or IV, 50 cases) according to the clinical condition grading standard in Guidelines for Diagnosis and Treatment of Acute Heart Failure. In addition, 105 healthy individuals examined in our medical center in the same period were selected as the control group. The serum LP-PLA2 and sST2 levels of all study objects were measured to analyze the correlation between these levels and AHF condition. Readmission due to heart failure and all-cause death were regarded as the endpoint events, and after one year of follow-up visits, the occurrence of the endpoint events in patients of the two groups was recorded, and with the endpoint events as the variable, the patients were divided into the event group and nonevent group to establish a logistic regression analysis model and analyze the merit of serum LP-PLA2 and sST2 in evaluating patient outcome. Results The patients' general information such as age and gender between the severe group and the mild group were not statistically different (P > 0.05), and the levels of high-sensitivity c-reactive protein (CRP), hemoglobin, creatinine, and uric acid of the severe group were greatly different from those of the mild group (P < 0.001), the comparison result of serum LP-PLA2 and sST2 levels was severe group > mild group > control group (P all <0.001), and the serum LP-PLA2 and sST2 levels of the severe group were, respectively, 275.98 ± 50.68 ng/ml and 2,122.65 ± 568.65 ng/ml; among 105 AHF patients, 50 of them had endpoint events (47.6%), including 36 in the severe group (36/50, 72.0%) and 14 in the mild group (14/55, 25.5%), and the event group presented greatly higher serum LP-PLA2 and sST2 levels than in the nonevent group (P < 0.001); according to the logistic regression analysis, serum LP-PLA2 and sST2 had independent predictive value for prognosis of AHF patients, which could be used as the independent predictive factors for 1-year prognosis. Conclusion Serum LP-PLA2 and sST2 have a good diagnosis value for the condition and prognosis of AHF patients, which shall be promoted and applied in practice.
Highlights
Being a kind of clinical syndrome that endangers patients’ lives, acute heart failure (AHF) refers to sudden heart failure (HF) or aggravation of the original HF signs, and AHF patients clinically show a significant decrease in cardiac contractility, a marked increase in cardiac workload, a sudden decline in cardiac output, and a dramatic rise in the pulmonary circulation pressure, which triggers symptoms such as pulmonary congestion, pulmonary edema, and cardiogenic shock [1, 2]
Journal of Healthcare Engineering patients with heart failure [3]; among 3,335 AHF patients prospectively registered at 14 hospitals in Beijing, 15% of them died within 30 d and 32.3% died at 1 year, and the patient death or readmission rate was as high as 60.0% [4], indicating that despite improved diagnosis and treatment of AHF, the short-term and long-term patient prognosis are still not promising
Since ventricular remodeling is a key element affecting the prognosis of HF patients, suppression of tumorigenicity 2 (ST2) in humans, which is related to the pathophysiology of ventricular remodeling, has been identified as an important indicator for assessing the prognosis of chronic HF (CHF) patients, and most studies have shown that this substance can act through the IL-33/ST2 pathway in the development and progression of HF [8, 9]
Summary
Being a kind of clinical syndrome that endangers patients’ lives, acute heart failure (AHF) refers to sudden heart failure (HF) or aggravation of the original HF signs, and AHF patients clinically show a significant decrease in cardiac contractility, a marked increase in cardiac workload, a sudden decline in cardiac output, and a dramatic rise in the pulmonary circulation pressure, which triggers symptoms such as pulmonary congestion, pulmonary edema, and cardiogenic shock [1, 2]. Since ventricular remodeling is a key element affecting the prognosis of HF patients, suppression of tumorigenicity 2 (ST2) in humans, which is related to the pathophysiology of ventricular remodeling, has been identified as an important indicator for assessing the prognosis of chronic HF (CHF) patients, and most studies have shown that this substance can act through the IL-33/ST2 pathway in the development and progression of HF [8, 9]. SST2 is the soluble ST2, and the PRIDE study demonstrated a positive association between sST2 levels and symptom severity by NYHA Functional Classification and that sST2 level was an independent factor for predicting the risk of mortality from acute dyspnea [10]. Lipoprotein-associated phospholipase A2 (LPPLA2) is an important inflammatory enzyme that leads to abnormal secretion of proinflammatory factors, and numerous epidemiological studies have shown that it is an independent predictor of cardiovascular events (CVEs), which can effectively assess the prognosis of cardiovascular disease (CVD) patients [11, 12]. The relationship between serum LP-PLA2 and sST2 levels and AHF condition and the predictive value for prognosis were investigated which is reported as follows
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