العلاقة بين التثبيط القابل للذوبان للأورام 2 (sST2) وبروتين ربط عامل النمو الشبيه بالأنسولين 2((IGFBP-2 مع درجة المخاطر القلبية لدى المرضى العراقيين الذين يعانون من الذبحة الصدرية غير المستقرة \ احتشاء عضلة القلب بدون ارتفاع ST

Association of Soluble Suppression of Tumorigenicity 2 (sST2) and Insulin-like Growth Factor Binding Protein 2 (IGFBP-2) with Cardiac Risk Score in Iraqi Patients with Unstable Angina \ Non-ST-Elevation Myocardial Infarction

Abstract

Both Non-ST-Elevation Myocardial Infarction (NSTEMI) and Unstable angina (UA) fall under the category of non-ST elevation acute coronary syndrome (NSTE-ACS). However, NSTEMI is differentiated from UA by the presence of acute myocardial necrosis. conducted an immediate risk assessment is crucial in order to determine whether persons with UA/NSTEMI require early invasive intervention. The Reynolds score, heart score, and TIMI score are prognostic tools used to evaluate the risk of cardiovascular events based on several variables. Suppression of Tumorigenicity 2(ST2), belonging to the Interleukin-1(IL-1) receptor family, exists in two forms: Suppression of Tumorigenicity 2 ligand(ST2L), which is a receptor linked to the cell membrane, and Soluble Suppression of Tumorigenicity 2(sST2), which is a soluble version found in the bloodstream. Insulin-like Growth Factor Binding Protein 2(IGFBP2), a constituent of the IGFBP family, modulates the activity of Insulin-like growth factors (IGFs) by engaging with them in the circulatory system and impeding their attachment to IGF receptors.
This study aimed to examine the correlation between sST2 and IGFBP-2 levels with TIMI score, Reynolds score, and heart score in patients with NSTE-ACS. The objective was to categorize the risk into low, moderate, and high based on clinical criteria. This categorization can assist clinicians in making more educated decisions regarding patient treatment options.
The present study is a case-control study includes 90 individuals aged between 44-70 years. (30 patients with NSTEMI, 30 patients with UA, and 30 individuals as a control group). The study was conducted at the Kerbala Heart Center. Where Specialist physicians assessed and diagnosed the patients. The participants were gathered over the duration spanning from October 2023 to January 2024 A questionnaire was conducted to gather patient information, including demographics, risk factors, medical history, physical examination results, and a range of blood tests such as sST2, IGFBP2, Pro_BNP, Hs-Troponin I, lipid profile test, hs-CRP, and creatinine levels.
Patients with NSTE-ACS had a significant decrease in The concentration of sST2 (p≤0.000) compared to the control group, there was no statistically significant difference in the level of IGFBP2 (p=0.560) between the patient group and the control group. On the other hand, There were no significant variations observed in the levels of sST2 and IGFBP2 among patients who were classified into three risk groups: low-risk, Medium-risk, and high-risk. The classification was based on the TIMI score, Reynolds score, and Heart score. The results of the receiver operating curve (ROC) demonstrated that sST2 had a fair performance as a diagnostic parameter for patients with NSTEMI and UA when compared to the control group. Additionally, the IGFBP2 level exhibited a fair performance as a diagnostic parameter for patients with UA when compared to the NSTEMI patients
In Conclusion patients with NSTE-ACS, exhibited a lower level of sST2 compared to control group possibly due to B-Blocker and ACE inhibitor medications enhancing left ventricle function and IL-33/ST2 signaling. On the other hand, there was no significant differences in IGFBP2 levels between the patient and control groups. However, the study found no significant differences in sST2 and IGFBP2 levels across different risk categories based on TIMI Score, Reynolds Score, and Heart Score in patient with NSTE-ACS. As a result, it was not possible to classify patients into Low, moderate, and high-risk groups using these biomarkers.