The Clinical Significance Of Serum Activin A And MLHFQ In Patients With Chronic Heart Failure

Objective: We measured the changes of the concentration of serum ACT-A inpatients with chronic heart failure, then analyzed the relationship between it andejection fraction, cardiac basic pathogen and the Minnesota living heart failurequestionnaire (MLHFQ). The adverse cardiac events in patients with heart failure wereassessed through combining the level of serum ACT-A with the application of MLHFQ.The purpose of this study is to further clarify clinic significance of serum ACT-A andMLHFQ in patients with chronic heart failure.Methods: Select98cases from150patients who were diagnosed with heartfailure according to the Framingham diagnosis and hospitalized in the department ofCardiology in the Second Affiliated Hospital of Dalian Medical University from June,2011to March,2012, then all the patients were classified as follows on the basis of thedisease: ischemic heart disease (n=34cases), hypertensive heart disease (n=22cases),valvular heart disease (n=16cases), dilated cardiomyopathy (n=26cases). While basedon the NYHA grading standards, all the selected patients are classified into four groups:29cases in class Ⅳ,31cases in class Ⅲ,18cases in class Ⅱ,20casesin class Ⅰ,meanwhile selecting the control group (n=20cases) with no hypertension or coronaryheart disease or diabetes mellitus at the same period. Firstly the heart failure groupcompared with the control group. Secondly the patients were divided to four groupsaccording to NYHA classification then compared with each other. Thirdly the HF groupwas classified into two parts according to the LVEF value from echocardiography:LVEF＞40%(n=51cases) and LVEF≤40%(n=47cases), the concentration of ACT-A,NT-proBNP and MLHFQ score were compared. Fourthly the heart failure group wasclassified based on the basic disease into four parts: ischemic heart disease group,hypertensive heart disease group, valvular heart disease group and dilated cardiomyopathy and then compared serum ACT-A, plasma NT-proBNP and MLHFQscores with every group. Fifthly all enrolled patients with heart failure were divided into3groups via MLHFQ score: MLHFQ＞75score(n=13cases),50score≤MLHFQ≤75score(n=52cases) and MLHFQ＜50score(n=33cases), then the concentration of serumACT-A and NT-proBNP were compared. We followed the patients for3months out ofhospital and recorded the cardiac adverse events. Classified these patients into two partson the basis of adverse cardiac occurrence, comparing the concentration of serumACT-A, plasma NT-proBNP and MLHFQ score; further compared the incidence ofadverse cardiac events in the patients with different serum ACT-A level and MLHFQscore. Combined serum ACT-A with MLHFQ score to assess the cardiac adverseevents.Results:1.Serum level of ACT-A in heart failure group (785.34±137.78pg/ml) wasobviously higher than that in control group (278.55±56.62pg/ml), and graduallyincreased with the deterioration of heart function [classⅠ(459.32±112.23),class Ⅱ(663.82±112.47pg/ml),classⅢ (801.39±143.78pg/ml),classⅣ (882.23±161.94pg/ml)，all P﹤0.05]. There was a significantly positive correlation between serum level ofACT-A with NYHA functional class(r=0.58, P﹤0.005) and plasma NT-proBNP(r=0.34,P﹤0.001).2.Compared with EF＞40%group and EF≤40%group, statistical analysisshowed that serum level of ACT-A, MLHFQ score and plasma NT-proBNP in EF≤40%group are all higher than those in EF＞40%group, so it was consideredstatistically significant (all P<＜0.05).3. There was no significant change of serum ACT-A, MLHFQ score and plasmaNT-proBNP in different basic pathogen group, so it wasn’t considered statisticallysignificant (all P>0.05).4. There was a significantly positive correlation between serum level of ACT-Awith MLHFQ score (r=0.57，P﹤0.001). The results of three groups according toMLHFQ was considered statistically significant (P<0.05), while there was no statisticalsignificance in plasma NT-proBNP (P>0.05).5. According to the follow-up observation of discharged patients for3months, wefind that the MLHFQ score, NT-proBNP and serum ACT-A content of the group withadverse cardiac event are obviously higher than that of the one without adverse cardiacevent. And with further study we can find that the incidence of adverse cardiac event of the group with ACT-A＞850pg/ml(48.5%) was obviously higher than that with ACT-A750-850pg/ml (33.3%)or ACT-A＜750pg/ml(13.9%); similarly, the incidence ofadverse cardiac event of the group with MLHFQ＞75(61.5%) was obviously higherthan that with50≤MLHFQ≤75(32,6%)and MLHFQ＜50(15.1%); if we classifythe patients into the following groups: one with ACT-A>850pg/ml, one with MLHFQ＞75, one with ACT-A＞850pg/ml and MLHFQ＞75, we could find that the incidence ofthe last group (70%) is obviously higher than that of other two groups (48.5%and61.5%).Conclusion:1. Serum ACT-A in heart failure group is significantly higher, and those valuesare gradually increased as the deterioration of cardiac function. It was suggested thatserum ACT-A level related to the severity of heart failure. The concentration of serumACT-A is positively correlated to the concentration of NYHA heart functionclassification, NT-proBNP and MLHFQ score, which suggest that serum ACT-A maybe involved in the development and progression of chronic heart failure.2. The higher ACT-A level and MLHFQ score, the higher the incidence of adversecardiac events and the poorer the prognosis.