立煬 ST2
The Best Tool For Heart
Failure Patient Management
產品專員 游騰傑
tsd@healthone-tw.com
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Outlines
Heart Failure
What is ST2
Heart Failure Management Mode
PresageR ST2 Assay Kit
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Heart Failure
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What is Heart Failure?
‧ Heart failure occurs when the heart is unable to pump sufficiently to
maintain blood flow to meet the needs of the body
當心臟無法充分提供以血流以滿足身體需要時，就會發生心力衰竭
http://www.heartfailurematters.org/
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Swollen Feet – Treatment And Home Remedies Life Style August 26, 2011
Heart Failure Classification
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Heart Failure Development
Clotting
Scarring
Fibrosis
Hypertrophy
Remodeling
Heart Failure
凝血 疤痕纖維化肥大 重塑心衰竭
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Fibrosis:
Remodeling:
The formation of excess fibrous
connective tissue in an organ or
tissue in a reparative or reactive
process
Changes of the gene expression
resulting in pattern reconstruction
in the structure, metabolism and
function of the heart
纖維化：
在修復或反應過程中在器官或組
織中形成過量的纖維結締組織
重塑：
基因表達的變化導致心臟的結構，
代謝和功能的模式重建
HF Epidemiology Worldwide
‧ There are 22.5 million HF patients with the annual rate of increase of 2 million patients, and its 5-year
survival rate is similar to that of cancer.
有2250萬HF患者，每年增加200萬患者，其5年生存率與癌症相似。
—World Health Statistics, World Health Organization 2010
- 世界衛生統計，2010年
‧ Among all diseases, the rehospitalization rate of patients older than 65 is highest in heart failure;3-6 month
readmission rate is 27%-47%.
— Hospital Compare: US Department of Health & Human Services (accessed April, 2013)
在所有疾病中，65歲以上患者的再住院率在心力衰竭中最高;
3-6個月再入院率為27％-47％。
- 醫院比較：美國衛生與人類服務部（2013年4月）
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Defects of Current HF Management
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‧
Early diagnosis is not popular
‧
How to identify the high-risk patients that need
aggressive treatment most
‧
How to adjust or determine drug dose
‧
No guidelines for hospital discharge
‧
Hard to monitor discharged patients
‧
How to know the risk of readmission
What is ST2
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Transmembrane ST2L and Soluble ST2
ST2 (growth STimulation expressed gene 2/ Suppression of Tumorigenicity 2 )
ST2 生長刺激表達基因2蛋白
Cell Membrane ST2L
IL-33
In serum/plasma ST2
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Slide from James Januzzi, MD
ST2: A DECOY RECEPTOR
Pro-IL-33
Fibroblast
Caspase-1
Myocyte
IRAK
IL-33
ST2L
MyD88
ERK
NFkB
ST2
Anti remodeling
Anti hypertrophy
Anti fibrosis
CARDIOPROTECTION
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Kakkar et al.(2008) Nat Rev Drug Discov,7: 827–840
IL-33 Eliminates Cardiomyocyte
Hypertrophy and Fibrosis in vivo
Scale bar：10 μm
When ST2 is knocked out…
IL-33 turns this…
Sanada et al.(2007) J. Clin. Invest.117:1538-49
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IL-33 has no effect
…into this…
Heart Failure Development
Clotting
Scarring
Fibrosis
Hypertrophy
Remodeling
Heart Failure
ST2
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Fibrosis:
Remodeling:
The formation of excess fibrous
connective tissue in an organ or
tissue in a reparative or reactive
process
Changes of the gene expression
resulting in pattern reconstruction
in the structure, metabolism and
function of the heart
ST2
2013 ACCF/AHA Guideline for the Management of Heart
Failure
First reported
1989
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ST2 expression in response to
myocardial stress and injury
2002
FDA/CE
新增為健保支付品項
2011 2013
2017
ACCF/AHA Guideline for the
Management of Heart Failure
Biomarkers of myocardial fibrosis are predictive of hospitalization and death in
patients with HF and also are additive to natriuretic peptide biomarker levels in
their prognostic value. A combination of biomarkers may ultimately prove to be
more informative than single biomarkers .
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When ST2>35ng/mL
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ST2
‧ Is
‧ a marker of fibrosis and worsening HF
‧ prognostic of 30-day rehospitalization
‧ NOT adversely impacted by impaired renal function or elevated BMI
腎功能受損或BMI升高不會對此產生不利影響
‧ Provides clinically actionable information about response to therapy
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