| ObjectivesThe purpose of this study was to discuss the diagnostic value of copeptin and Carbohydrate antigen-125(Ca-125)in acute left heart failure patients with persistent or permanent atrial fibrillation and the relationships of copeptin and Ca-125 with cardiovascular events(recurrent acute left heart failure,cardiogenic shock,cardiogenic death,cerebral infarction).Under the guidance of our results,copeptin and Ca-125 laid the foundation for diagnosis and prognosis in patients with acute heart failure and atrial fibrillation.MethodsAs a case-control study,patients with acute left heart failure or atrial fibrillation or both coexistence were recruited from January 2016 to February 2017 in our hospital department of Cardiology emergency or outpatient hospital as case subjects.Patients without acute left heart failure and atrial fibrillation hospitalized in the same period were recruited as control subjects.The continuous variables of normal distribution were expressed by mean±SD(x2±s),and the differences were determined by one-way analysis of variance.The SNK test was used for multiple comparisons between groups.The classification variables were expressed by frequencies(percentile),and the comparisons were analysed by chi square test(x2 test).We used the area under the curve of ROC to evaluate the diagnostic value of copeptin and Ca-125 in patients with acute heart failure and atrial fibrillation.The correlation of data with normal distribution were analysed by Pearson correlation analysis,or else by Spearman correlation analysis.The significance level was defined as P<0.05.Results1.The copeptin,Ca-125 and N-terminal pro-B-type Natriuretic Peptide(NT-proBNP)were highest in the acute left heart failure with atrial fibrillation group,followed successively by acute left heart failure with sinus rhythm group,atrial fibrillation without heart failure group,control group.There were significant differences between groups(P<0.05).2.In the acute left heart failure with atrial fibrillation group,we found that copeptin and Ca-125 were positively correlated with NT-proBNP(r=0.615 and r=0.510,respectively,P<0.001).3.Left atrial diameter(LAD)and left ventricular diameter(LVD)were largest and left ventricular ejection fraction(LVEF)was lowest in the acute left heart failure with atrial fibrillation group,followed successively by acute left heart failure with sinus rhythm group,atrial fibrillation without heart failure group,control group.There were significant differences between groups(P<0.05).4.In the acute left heart failure with atrial fibrillation group,we found that copeptin was positively correlated with LAD and LVD(r=0.479 and r=0.513,respectively,P<0.001),and negatively correlated with LVEF(r=-0.626,P<0.001).Besides,in the same group Ca-125 was positively correlated with LAD and LVD(r=0.479 and r=0.513,respectively,P<0.001),and negatively correlated with LVEF(r=-0.626,P<0.001).5.Uric acid(UA),D-dimer,C-Reactive protein(CRP)were highest in the acute left heart failure with atrial fibrillation group,followed successively by acute left heart failure with sinus rhythm group,atrial fibrillation without heart failure group,control group.On the contrary,albumin(ALB)was lowest in the acute left heart failure with atrial fibrillation group.6.There were positive correlations between copeptin and D-dimer,copeptin and CRP,Ca-125 and D-dimer,Ca-125 and CRP(r=0.430,r=0.260,r=0.401,r=0.248,respectively,P<0.05)in the acute left heart failure with atrial fibrillation group.However,there was negative correlation between copeptin and ALB(r=-0.387,P<0.001).7.The areas under the curve of copeptin and Ca-125 were 0.950 and 0.830 respectively(P<0.05).The diagnosis accurate rate of copeptin was 0.950,which of Ca-125 was 0.823.With the best diagnostic point as 20.91 pmol/L in the acute left heart failure with atrial fibrillation patients,the sensitivity of copeptin was 95.52%and the specificity was 86.30%.The best diagnostic point of Ca-125 was 31.18 U/ml,where the sensitivity was 62.69%and the specificity was 88.37%.8.There were 41 times of cardiovascular events(3 months after discharge)in the acute left heart failure with atrial fibrillation group,including 33 times of recurrent acute left heart failure,3 times of cardiogenic shock,3 times of cardiogenic death,and 2 times of acute cerebral infarction.We found that copeptin and Ca-125 were positively correlated with short-term cardiovascular events(r=0.493 and r=0.518,respectively,P=0.000).Conclusions1.The copeptin and Ca-125 were highest in the acute left heart failure with atrial fibrillation group,which were positively correlated with NT-proBNP.2.In the acuteleft heart failure with atrial fibrillation group,both copeptin and Ca-125 were positively correlated with LAD and LVD,and negatively correlated with LVEF.3.There were positive correlations between copeptin and D-dimer,copeptin and CRP,Ca-125 and D-dimer,Ca-125 and CRP in the acute left heart failure with atrial fibrillation group.However,negative correlation was found between copeptin and ALB,and no correlations were found between copeptin,Ca-125 and UA.4.The diagnosis accurate rate of copeptin was 0.950,which of Ca-125 was 0.823.With the best diagnostic point as 20.91 pmol/L in the acute left heart failure with atrial fibrillation patients,the sensitivity of copeptin was 95.52%and the specificity was 86.30%.The best diagnostic point of Ca-125 was 31.18 U/ml,where the sensitivity was 62.69%and the specificity was 88.37%.5.In the acute left heart failure with atrial fibrillation group,copeptin and Ca-125 were positively correlated with short-term cardiovascular events. |
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