关键词: 可溶性生长刺激表达基因2蛋白, 白细胞介素-6, C反应蛋白, 左心室辅助装置, 终末期心力衰竭, 主要不良心血管事件

Abstract:

Objective To investigate the roles of soluble growth stimulation-expressed gene 2 protein（sST2），interleukin（IL）-6 and C-reactive protein（CRP）in predicting the occurrence of major adverse cardiovascular events（MACE）within 6 months after left ventricular assist device（LVAD）implantation in patients with end-stage heart failure（ESHF）. Methods Totally，50 patients with ESHF who underwent HeartCon LVAD implantation at TEDA International Cardiovascular Hospital from June 2022 to March 2025 were enrolled. The clinical data were collected，and the levels of sST2，IL-6 and CRP were determined before the operation and at 1，7，30，60 and 90 d after the operation. All the patients were followed up for 6 months. The occurrence of MACE（including death and rehospitalization due to right heart failure）was recorded. The patients were classified into non-MACE group（45 cases）and MACE group（5 cases）. Cox regression analysis was used to evaluate the influencing factors of MACE after LVAD implantation in ESHF patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of each indicator in predicting MACE after LVAD implantation in ESHF patients. Kaplan-Meier survival curve was used to analyze the occurrence of MACE within 6 months after LVAD implantation in ESHF patients. Results Compared with preoperative levels，the levels of sST2，IL-6 and CRP in ESHF patients increased synchronously on the first day after the operation and reached the peak，and then gradually decreased，stabilizing at the 90th day after the operation. The sST2 level on the 30th and 90th day after the operation in MACE group and the IL-6 and CRP levels on the 90th day after the operation in MACE group were higher than those in non-MACE group（P<0.05）. There was no statistical significance in the levels of sST2，IL-6 and CRP between the 2 groups at the other time points（P>0.05）. There was no statistical significance in the incidence of MACE within 6 months after LVAD implantation among ESHF patients with different etiologies（dilated cardiomyopathy，ischemic cardiomyopathy）（P>0.05）. The levels of sST2 on the 30th day，CRP on the 60th day after the operation and IL-6 and CRP levels on the 90th day after the operation were risk factors for MACE occurrence within 6 months after LVAD implantation in LVAD patients（P<0.05）. The areas under curves（AUC）for predicting MACE after LVAD implantation in ESHF patients by sST2 on the 30th day and IL-6 and CRP on the 90th day were 0.875，0.785 and 0.796，respectively. According to the optimal cut-off values of sST2 on the 30th day and IL-6 and CRP on the 90th day，ESHF patients were classified into high-level and low-level groups. The incidence of MACE within 6 months after the operation was higher in high-level groups of sST2 on the 30th day，IL-6 on the 90th day and CRP on the 90th day than in low-level groups（P<0.05）. Conclusions The sST2 on the 30th day and IL-6 and CRP on the 90th day after LVAD implantation have certain predictive value for the occurrence of MACE within 6 months after ESHF patients undergoing LVAD implantation.

Key words: Soluble growth stimulation-expressed gene 2 protein, Interleukin-6, C-reactive protein, Left ventricular assist device, End-stage heart failure, Major adverse cardiovascular event