| Objective: To evaluate the predictive value of GDF-15 for mortality and the heart failure in perioperative period.Method:The patients who were the first time to undergoing OPCAB in Department of cardiovascular surgery of Tianjin Chest Hospital were included in this study.The changes of GDF-15 level,BNP,blood lipid level,demographic characteristics,and echocardiographic findings,NYHA classification in the preoperative,postoperative and long-term were recorded.1.A total of 200 consecutive patients undergoing OPCABG were included in this study.Demographic characteristics,past medical history,echocardiographic findings,and plasma levels of GDF-15 and BNP were measured.2.All the patients were followed up for two years,with all-cause mortality as the primary end point,with recurrent cardiovascular events for the secondary end point.The plasma levels of GDF-15 and BNP were compared at 24 hours preoperation,2 weeks after operation,and three months after operation;3.According to the experimental data,the grouping method is as follows:1)According to the preoperative plasma GDF-15 levels,patients were divided into 2 groups: study group,GDF-15 > 1200ng/L;control group,GDF-15 <1200ng/L,to compare the correlation between the basic features of the patients in the study group and the control group.2)According to the preoperative plasma BNP levels,patients were divided into2 groups,groups: study group,BNP>100ng/L;control group,BNP<1200ng/L,to compare the correlation between the basic features of the patients in the study group and the control group;3)According to NYHA classification,patients were divided into 4 groups,to compare the levels and trends of plasma GDF-15 and BNP.4)According to the patients suffered from heart failure or not the patient were divided into 2 groups,the plasma GDF-15 and BNP levels were compared between the two groups,to analysis whether the plasma levels of GDF-15 and BNP in the two groups were statistically different;5)According to the GDF-15 value of the patients with 1200ng/L and BNP value as 100pg/ml,the patients divided into two groups,to compared the specificity of the two laboratory tests for the diagnosis of heart failure;4.Optimal performance test: according to the data of the patients,the ROC curve was drawn to evaluate the predictive value of GDF-15 and BNP in patients with heart failure.Result:1.The overall results of follow-up: This study included a total of 200 patients,193 patients were followed up after 2 years,the follow-up rate was 96.5%,28 patients suffered from non-fatal cardiovascular events after 1 weeks post-operation: 27 patients suffered from acute left heart failure,1 patients suffered from non-fatal pulmonary embolism,no patient died.Long term follow-up studies showed in study group(GDF-15>1200ng/L):12 patients suffered from chronic heart failure,accounting for 23.07% of the study group;5 patients were re admitted due to pulmonary embolism,accounting for 9.62% of the patients in this group.7 patients were re admitted due to myocardial infarction,accounting for 13.46% of the patients in this group;3 patients suffered from cerebral ischemia or stroke,accounting for 5.77% of the patients in this group.8 patients died,accounting for 15.38% of the patients;in control group,(GDF-15<1200ng/L),3patients suffered from chronic heart failure,accounting for 2.03% of the patients;1patients were re admitted due to pulmonary embolism,accounting for 0.68% of thepatients in this group.3 patients were re admitted due to myocardial infarction,accounting for 2.03% of the patients in this group;no patients suffered from cerebral ischemia or stroke,3 patients died,accounting for 2.03% of the patients.The incidence of adverse events of control group(GDF-15<1200ng/L)was lower than that in study group of GDF-15> 1200ng/L,and the difference was statistically significant(P<0.05).In the group of BNP>100pg/ml,14 patients suffered from chronic heart failure,accounting for 21.21% of the patients in this group;3 patients were re admitted due to pulmonary embolism,accounting for 4.55% of the patients in this group.8 patients were re admitted due to myocardial infarction,accounting for 12.12% of the patients in this group;2 patients suffered from cerebral ischemia or stroke,accounting for 3.03% of the patients in this group.10 patients died,accounting for 15.15% of the patients.In the group of BNP<100pg/ml,1 patients suffered from chronic heart failure,accounting for 0.75% of the patients in this group;3 patients were re admitted due to pulmonary embolism,accounting for2.24% of the patients in this group.2 patients were re admitted due to myocardial infarction,accounting for 1.49% of the patients in this group;1 patients suffered from cerebral ischemia or stroke,accounting for 0.75% of the patients in this group.1 patients died,accounting for 0.75% of the patients.The incidence of adverse events of control group(BNP<100pg/ml)was lower than that in study group of BNP>100pg/ml,and the difference was statistically significant(P<0.05);2.The preoperative proportion of patients with hypertension,diabetes mellitus and hyperlipidemia of plasma GDF-15 > 1200ng/L was higher than that of the control group;3.The preoperative proportion of patients with hypertension,diabetes and hyperlipidemia BNP > 100ng/L group was higher than that in control group(P<0.05);4.Grouped according to the NYHA classification,GDF-15 and BNP levels increased progressively,and the differences were statistically significant(P<0.05);5.The plasma GDF-15 and BNP levels in the 5 heart failure group and non-heart failure group were statistically different;6.According to the value of GDF-15 for 1200ng/L and BNP for numerical100pg/ml,statistics found that non-heart failure patients in 17 cases of GDF-15>1200ng/L,BNP>100pg/ml 21 cases,the two cases showed that the index of laboratory examination is less specific;7.The results of excellent and simple test: BNP and GDF-15 were statistically significant in the diagnosis of heart failure patients,and the area under the BNP curve of ROC was larger than GDF-15,which showed BNP is more powerful than GDF-15 in the diagnosis of heart failure.Conclusion:1.GDF-15 which is as a new quantitative marker of heart failure in perioperative period of OPCAB has a high clinical value in the diagnosis of perioperative heart failure and the prognosis of patients with postoperative heart failure;2.The combined detection of plasma BNP and GDF-15 is of clinical significance for the evaluation of postoperative OPCABG.It can be used as an ideal indicator for the diagnosis of acute myocardial infarction;3.The sensitivity and specificity of GDF-15 in plasma were similar to those of BNP,and have a strong ability to evaluate the prognosis of patients;4.Elevated plasma BNP and GDF-15 levels may indicate a poor prognosis in patients with OPCABG after two years. |
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