Expression And Clinical Significance Of Soluble AXL In Patients With Heart Failure With Preserved Ejection Fraction

Objective: To observe the level of serum soluble AXL(sAXL)in patients with heart failure with preserved ejection fraction(HFpEF).The correlation with of New York Heart Association(NYHA)functional class,N-terminal pro-brain natriuretic peptide(NT-proBNP)and echocardiograhic functional parameters.To investigate the clinical significance of serum sAXL in the diagnosis of heart failure with preserved ejection fraction and the evaluation of cardiac function.Methods: From January twenty eighteen to December twenty eighteen,117 patients with chronic heart failure hospitalized in the Department of Cardiology of Affiliated Zhongshan Hospital of Dalian University were divided into HFpEF group(n=91)and HFrEF group(n=26)according to the diagnostic criteria based on the 2016 ESC guidelines for diagnosis and treatment of Acute and chronic Heart failure.According to NYHA cardiac function classification,HFpEF group was divided into three subgroups: cardiac function grade Ⅱ group(n=37),cardiac function grade Ⅲ group(n=30)and cardiac function grade Ⅳ group(n=24).Sixty non-heart failure patients hospitalized in the same period were selected as the control group.The general data(age,sex,BMI,blood pressure,etc.)were collected,and the whole blood was collected on the day after admission to examine NT-proBNP and biochemical indicators.Some samples were frozen at-80℃ after separation of serum.The concentration of sAXL was detected by ELISA double antibody sandwich method.Echocardiography was performed within 48 hours after admission,and cardiac function indexes were recorded.Variance analysis was used for normal distribution data,rank sum test was used for non-normal distribution data,chi-square test was used to compare counting data,Spearman correlation factor analysis was used to analyze the influencing factors of sAXL,and ROC curve was used to predict the diagnostic value of sAXL for HFpEF.Results: The levels of serum sAXL in HFpEF group,HFrEF group and control group were 76.62±17.78ng/L,79.97±14.26ng/L and 43.6±4.99ng/L,HFpEF group and HFrEF group,respectively,which were significantly higher than those in control group(P < 0.01).However,there was no significant difference in serum sAXL level between HFpEF group and HFrEF group(P > 0.05).In the subgroup analysis of HFpEF group,the level of serum sAXL increased gradually with the increase of NYHA grade in HFpEF group,and there was significant difference among the subgroups(P<0.01).Spearman correlation and further multiple linear regression analysis showed that serum sAXL level was positively correlated with serum NT-proBNP level and diabetes mellitus in HFpEF group(The r values were 0.339 and 0.3960,P < 0.05).There was no significant correlation with LAD,IVSD,E/e’,LVEDD and LVPWD.The area under the ROC curve showed that when the optimum tangent point of sAXL was 52.68ng/L,the sensitivity,specificity and area under the curve were 90.1%,68.6% and 0.796 respectively(P < 0.05,95% CI: 0.693-0.844).Conclusions: 1.The level of serum sAXL in patients with HFpEF and HFrEF is significantly higher than that in patients with non-heart failure,but there is no significant difference in the level of serum sAXL between patients with HFpEF and HFrEF.2.The level of serum sAXL increased with the severity of HFpEF heart failure.3.The level of serum sAXL in patients with HFpEF is positively correlated with the incidence of NT-proBNP and diabetes mellitus.4.Serum sAXL has certain clinical value in the diagnosis and severity evaluation of HFpEF patients.