Application Value Of Heart Failure Biomarkers In Elderly Patients With Chronic Heart Failure

Part I: Application value of heart failure biomarkers in the evaluation of chronic heart failure in the elderly patientsObjectiveTo understand the relationship between the levels of plasma B-type brain natriuretic peptide（BNP）,serum C-reactive protein（CRP）,serum cardiac troponin I（cTnI）and ventricular function and left ventricular remodeling in elderly patients with chronic heart failure,and to explore the application value of heart failure biomarkers plasma brain natriuretic peptide（BNP）,serum C-reactive protein（CRP）and serum cardiac troponin I（cTnI）in evaluating the severity of chronic heart failure in elderly patients.Methods328 elderly patients with chronic heart failure were selected as the observation group,and 60 healthy elderly patients were selected as the control group.Elderly patients with chronic heart failure（CHF）were grouped according to the New York Heart Association（NYHA）classification criteria into grades II to IV;There were 102 elderly patients with chronic heart failure with heart function II,137 patients with heart function III and 89 patients with heart function IV.The levels of b-type brain natriuretic peptide（BNP）,C-reactive protein（CRP）,troponin I（cTnI）,alanine aminotransferase（ALT）,serum creatinine,urea nitrogen,total cholesterol,low density lipoprotein,fasting blood glucose and uric acid were measured in all selected patients.At the same time,left ventricular ejection fraction（LVEF）、Left ventricular end diastolic diameter（LVEDD）、 Ventricular septal thickness（IVST）,、left ventricular posterior wall thickness（LVPWT）were measured by cardiac color ultrasound;LVMI index of left ventricular mass was measured by echocardiography.Results3.1 Comparison of general data,BNP,CRP,cTnI and ventricular remodeling indexes between the elderly patients with chronic heart failure and the control groupThere were no significant differences in age,gender and BMI between the two groups（age: 71.9±10.7vs70.7±11.9,t=0.661,P=0.501;Gender（male: female）: 190/138 vs 35/25,c2=0.003,P=0.953;BMI（kg/m2）: 25.21±3.62 vs 24.82±3.54,t=0.654,P=0.520）.However,the levels of BNP,CRP,cTnI,LVEDD and LVMI in elderly patients with chronic heart failure were higher than those in the control group（BNP:597.81±192.00 vs 44.92± 10.87,t =22.282,P<0.001,）and CRP : 21.90± 9.34 vs6.23±2.85,t = 12.871,P<0.001;cTnI: 0.55±0.29 vs 0.05±0.01,t=13,342,P<0.001;LVEDD: 50.92±6.36 vs 43.91±5.12,t=8.071,P<0.001;LVMI:158.13±18.63 vs85.89±13.18,t=28.731,P<0.001).The level of LVEF in observation group was lower than that in control group（LVEF 44.66±6.46 vs 55.82±7.82,t=11.892,P<0.001）.There was no difference in IVST and LVPWT between the two groups（IVST: 8.87±0.71 vs8.93±0.63,t=0.501,P=0.601;LVPWT: 8.83±0.69 vs 8.94±0.75,t=0.943,P=0.346）.3.2 Comparison of general data of elderly patients with chronic heart failure at different levels of heart function（GRADE II-IV）There were no significant differences in gender,age,hypertension,type 2 diabetes,hyperlipidemia and cerebral infarction among the three groups of elderly patients with chronic heart failure（gender（male: female）: 62/40 vs 82/55 vs 46/43,c2=1.973,P=0.373,age:71.3±7.6 vs 71.1±8.5 vs.72.4±7.6,F=0.768,P= 0.465;Hypertension:78/102 vs 102/137 vs 65/89,c2=0.140,P=0.932;Type 2 diabetes mellitus: 47/102 vs56/137 vs 48/89,c2=3.702,P=0.157;Hyperlipidemia: 42/102 vs 58/137 vs 49/89,c2=4.600,P=0.100;Cerebral infarction: 39/102 vs 51/137 vs 42/89,c2=2.476,P=0.290）.The incidence of CHD was significantly higher in patients with grade IV chronic heart function than in patients with grade II and III chronic heart function（CHD: 68/102 vs98/137 vs 80/89,c2=15.177,P=0.001）.3.3 Comparison of BNP,CRP,cTnI and ventricular remodeling in elderly patients with chronic heart failure in the concentric function groupThe serum BNP,CRP,cTnI,LVEDD and LVMI indexes of the elderly patients with chronic heart failure grade IV group were higher than those of the elderly patients with chronic heart failure grade III group and grade II group,and the LVEF index of the elderly patients with chronic heart failure group was lower than that of the elderly patients with chronic heart failure grade III group and grade II group.The serum BNP,CRP,cTnI,LVEDD and LVMI indexes in patients with grade III chronic heart failure group were higher than those in patients with grade II chronic heart failure group,and the LVEF index in patients with grade II chronic heart failure group was lower than that in patients with grade II chronic heart failure group（P<0.001）,However,there was no significant difference in IVST and LVPWT indexes among elderly patients with chronic heart failure in each group（P>0.05）.3.4 Correlation between BNP and ventricular remodeling in patients with chronic heart failureSubgroup analysis showed that serum BNP levels were positively correlated with LVEDD and LVMI in elderly patients with chronic heart failure（r=0.569,P<0.001 and r=0.916,P<0.001）,but negatively correlated with LVEF（r=0.349,P<0.001）.3.5 Correlation between CRP and ventricular remodeling in patients with chronic heart failureIn subgroup study,serum CRP level was positively correlated with LVEDD and LVMI（r=0.458,P<0.001 and r=0.749,P<0.001）,but negatively correlated with LVEF（r=0.375,P<0.001）.3.6 Correlation between cTnI and ventricular remodeling in patients with chronic heart failureSubgroup analysis showed that serum cTnI levels were positively correlated with LVEDD and LVMI（r=0.332,P<0.001 and r=0.559,P<0.001）,but negatively correlated with LVEF（r=0.221,P<0.001）.Conclusion1.The biomarkers of heart failure in elderly patients with chronic heart failure showed high expression of plasma BNP,serum CRP and serum cTnI,and the levels of plasma BNP,serum CRP and serum cTnI increased with the increase of cardiac function grade in elderly patients with chronic heart failure,and there was a positive correlation between them.2.There was a positive correlation between the levels of BNP,CRP and cTnI,the biomarkers of heart failure in elderly patients with different functional grades of chronic heart failure,and LVEDD and LVMI index.3.The levels of BNP,CRP and cTnI,biomarkers of heart failure in elderly patients with different functional grades of chronic heart failure,were negatively correlated with LVEF.Part II Application value of heart failure biomarkers in prognosis evaluation of elderly patients with chronic heart failureObjectiveThis study analyzed the relationship between the levels of plasma B-type brain natriuretic peptide（BNP）,serum cardiac troponin（cTnI）and C-reactive protein（CRP）and the recurrence of cardiovascular events in elderly patients with chronic heart failure;To explore the predictive value of plasma B-type brain natriuretic peptide（BNP）,serum cardiac troponin（cTnI）,C-reactive protein（CRP）and their combined detection on recurrent cardiovascular events in elderly patients with chronic heart failure,so as to provide a theoretical basis for the accurate evaluation of the prognosis of elderly patients with chronic heart failure.MethodsIn this study,328 elderly patients with chronic heart failure were treated in our hospital from January 2020 to June 2021.The follow-up time was 24 months to understand the recurrence of cardiovascular events in elderly patients with chronic heart failure（cardiovascular events include malignant ventricular arrhythmia,rehospitalization due to aggravation of heart failure,cardiac death due to heart failure and malignant arrhythmia,etc.）.Cox regression analysis was used to explore the correlation between plasma B-type brain natriuretic peptide（BNP）,serum cardiac troponin（cTnI）,serum C-reactive protein（CRP）and recurrent cardiovascular events in elderly patients with chronic heart failure;The ROC curves of plasma B-type brain natriuretic peptide（BNP）,serum cardiac troponin（cTnI）,serum C-reactive protein（CRP）and their combined detection on the prognosis of elderly patients with chronic heart failure were drawn,and the survival rate was predicted by Kaplan-Meier survival curve;Univariate / multivariate Cox regression was used to analyze the related risk factors of cardiovascular events.Result1.Prognostic value of plasma BNP level in elderly patients with chronic heart failure:The results showed that plasma BNP level was positively correlated with recurrent cardiovascular events in elderly patients with chronic heart failure（P<0.001）;The area under the curve（AUC）was 0.834,95% CI: 0.817-0.940;When the cut-off value of plasma BNP=591.64pg/ml,its sensitivity=0.83 and specificity=0.79（P<0.001）;Further Kaplan-Meier survival analysis showed that the median time of vascular events in elderly patients with chronic heart failure with high-level BNP was 17.2 months（c2=91.087,95% CI: 14.9-17.6,P<0.001）.2.Prognostic value of serum cTnI level in elderly patients with chronic heart failure:The results showed that the level of serum cTnI was positively correlated with recurrent cardiovascular events in elderly patients with chronic heart failure（P<0.05）;The area under the curve（AUC）was 0.809,95% CI: 0.785-0.887;When the cut-off value of serum cTnI=0.62ng/ml,the sensitivity=0.80 and the specificity=0.78（P<0.001）;Further Kaplan-Meier survival analysis showed that the median time of vascular events in elderly patients with chronic heart failure with high-level cTnI was 17.6 months（c2 =118.840,95% CI: 16.5-18.7,P<0.001）.3.Prognostic value of serum CRP level in elderly patients with chronic heart failure:The results showed that serum CRP level was positively correlated with recurrent cardiovascular events in elderly patients with chronic heart failure（P<0.001）;The area under the curve（AUC）was 0.786,95% CI: 0.692-0.840;When the cut-off value of serum CRP=28.20mg/l,its sensitivity=0.79 and specificity=0.76（P<0.001）;Further Kaplan-Meier survival analysis showed that the median time of vascular events in elderly patients with chronic heart failure with high-level CRP was 18.2 months（c2=183.874,95% CI: 17.2-19.3,P<0.001）.4.Prognostic value of combined detection of plasma BNP,serum cTnI and CRP in elderly patients with chronic heart failure:The results of this study showed that three heart failure markers were used as the ROC curve to judge the prognosis of elderly patients with chronic heart failure,and the area under the curve（AUC）was AUC = 0.852;95% CI: 0.809-0.941,sensitivity=0.86,specificity=0.83（P<0.001）,indicating that the sensitivity and specificity of combined detection are higher than those of single index detection;The median time of vascular events in elderly patients with chronic heart failure in the high-risk group was 16.1months（c2=121.640,95% CI: 14.8-17.3,P<0.001）.Conclusions1.The ROC curve analysis showed that the biomarkers of heart failure plasma BNP,serum cTnI and CRP had high sensitivity and specificity in predicting the risk of cardiovascular events in elderly patients with chronic heart failure.Further Cox regression analysis showed that plasma BNP,serum cTnI and CRP could be used as independent risk factors for cardiovascular events in elderly patients with chronic heart failure within 2 years.2.The ROC curve analysis showed that the specificity and sensitivity of the combined detection of heart failure biomarkers plasma BNP,serum cTnI and serum CRP in predicting the recurrence of cardiovascular events in elderly patients with chronic heart failure were higher than those of a single detection index;Further Kaplan Meier survival analysis found that the survival rate of elderly patients with chronic heart failure in the high-risk group was lower,suggesting that such patients had a higher risk of recurrent cardiovascular events.It showed that the combined detection of multiple heart failure biomarkers was helpful to identify and screen patients at high risk of recurrent cardiovascular events,The results show that the combined detection of heart failure biomarkers can be used as a good index to predict the recurrence of cardiovascularevents in elderly patients with chronic heart failure;Therefore,the combined detection of multiple heart failure biomarkers can improve the accuracy of prognosis evaluation of elderly patients with chronic heart failure,and can be used to guide the personalized and accurate management of elderly patients with chronic heart failure.