| Objective:To investigate the effects of plasma von Willebrand factor(vWF),soluble suppression of tumorigenicity-2(sST2),growth differentiation factor-15(GDF-15)and B-type natriuretic peptides(BNP)on diagnosis,risk stratification and short-term prognosison heart failure with preserved ejection fraction(HFpEF).Methods:118 patients with chronic heart failure(CHF)as the main cause of hospitalization from July 2018 to December 2018 were selected successively in the Department of Cardiology of our hospital.All the selected patients met the diagnostic criteria of heart failure in China heart failure diagnosis and treatment guide 2014,and were divided into two groups according to left ventricular ejection fraction(LVEF).57 patients with LVEF≥ 50%were divided into heart failure with preserved ejection fraction(HFpEF group)and 61 patients with LVEF<50%were divided into heart failure with reduced ejection fraction(HFrEF group).According to the New York Heart Disease Association(NYHA)heart function classification,they were further divided into three subgroups:Grade Ⅱ,grade Ⅲ and grade Ⅳ.58 healthy examinees without heart failure and history of heart diseases were included in the physical examination center of our hospital at the same time as the control group.Collect and record the general situation of gender,age,weight,height,smoking and drinking history,physical examination results,NYHA heart function classification,heart failure cause,previous concomitant diseases and medication of all the candidates,calculate the body mass index,and collect and record the item values detected by the laboratory:BNP,fasting blood glucose(Glu),total cholesterol(TC),triglyceride TG,LDL-C,HDL-C,LP,ALT,AST,albumin,bun,Cr,K,Na,C1,CO2 binding capacity,Myocardial enzyme spectrum,hs CRP,blood routine test,D-dimer.The cardiac structure and left ventricular function were evaluated by echocardiography in 48h after admission.Patients with heart failure and control group were followed up for 6 months,and the end events(readmission and all-cause death due to aggravation of heart failure)were recorded 6 months after discharge.The concentrations of vWF,ST2 and GDF-15 in three groups of subjects were detected by ABC-ELISA.The differences of vWF,ST2 and GDF-15 in three groups of subjects were compared.The correlations of BNP,vWF,ST2 and GDF-15 with NYHA were compared by Spearman correlation analysis.The correlations of BNP,vWF,ST2 and GDF-15 with LVEF and BNP were compared by Pearson correlation analysis.The working characteristics of subjects were analyzed the area under curve(AUC)of receiver operating characteristic curve(ROC curve)was used to analyze the value of BNP,vWF,ST2 and GDF-15 in the diagnosis,risk stratification and prognosis of HFpEF.Results:(1)compared with the control group,HFpEF group was older(74.56±10.15)than HFrEF group(65.46±13.55),women accounted for 61.4%,patients with hypertension accounted for 59.6%,patients with atrial fibrillation/flutter accounted for 52.6%,systolic blood pressure(139.77±25.74)mmHg,NYHA heart function grade Ⅱand Ⅲ accounted for the majority,17 cases(29.8%)and 25 cases(43.9%)respectively,which were higher than HFrEF group.There was significant difference between the two groups(P<0.01).In contrast,20 patients(32.8%)with renal insufficiency,36 patients(59.0%)with grade Ⅳ cardiac function,blood uric acid(474.02±178.25)umol/L,hemoglobin(133.02±28.48)g/L in HFrEF group were higher than those in HFpEF group,with significant difference between the two groups(P<0.01);(2)compared with the basic causes of heart failure,the common causes of HFpEF were ischemic cardiomyopathy and valvular disease,while HFrEF The common causes were ischemic cardiomyopathy and dilated cardiomyopathy.There was significant difference between the two groups(P<0.05).The results showed that the LVEF,E/A ratio of heart failure group was significantly lower than that of normal control group,and the LAED,LVEDd and IVST were significantly higher than that of normal control group(P<0.01)(3)The concentrations of BNP,vWF,sST2 and GDF-15 in the heart failure group were significantly higher than those in the control group.The concentrations of BNP,vWF and ST2 in HFpEF group were lower than those in HFrEF group,and there was significant difference between the two groups(P<0.01),but there was no significant difference between the two groups.Through Spearman correlation analysis,we found that BNP,vWF,sST2 and GDF-15 were positively correlated with NYHA grade in HFpEF group,r-value was 0.340,0.398,0.294 and 0.306,P value was 0.010,0.002,0.046 and 0.021,respectively,and the above markers were positively correlated with NYHA grade in hfreef group,r-value was 0.285,0.308,0.279 and 0.273,P value was 0.026,0.016,0.029 and 0.033,respectively;Pearson correlation analysis showed that BNP,vWF,sST2 and GDF-15 were not correlated with LVEF in the control group and HFpEF group,but were negatively correlated with LVEF in HFrEF group,with r-values of-0.303,-0.349,-0.339,-0.340,P values of 0.018,0.006,0.001 and 0.007,respectively;vWF,sST2 and GDF-15 in HFpEF group were positively correlated with BNP,with r-values of 0.855,0.896 and 0 885,P<0.01;(4)ROC curves of BNP,vWF,sST2 and GDF-15 were used to diagnose HFpEF.The sensitivity was 98.2%,The AUC of plasma GDF-15 in HFPEF diagnosis was 0.714(95%CI:0.640-0.789),the best threshold was 11.28pg/ml,the sensitivity was 98.5%,the specificity was 54.6%;the AUC of plasma VWF+BNP in HFpEF diagnosis was 0.717(95%CI:0.645-0.789);the AUC of plasma ST2+BNP in HFpEF diagnosis was 0.691(95%CI:0.612-0.769);The AUC of plasma GDF-15+ BNP for HFpEF was 0.752(95%CI:0.663-0.841);the AUC of plasma VWF+sst2+ GDF-15+BNP for HFpEF was 0.775(95%CI:0.697-0.852);(5)the ROC curve of plasma BNP,vWF,sST2 and GDF-15 for predicting all-cause death/cardiogenic readmission in HFpEF patients.The AUC of all-cause death/cardiogenic read-mission predicted by plasma BNP was 0.527(95%CI:0.374～0.680),the best threshold was 344.5pg/ml,the sensitivity was 55.6%,and the specificity was 56.4%;the AUC of all-cause death/cardiogenic readmission predicted by plasma vWF was 0.533(95%CI:0.376～0.691),the best threshold was 183mU/ml,and the sensitivity was 55.6%,the specificity was 53.8%;the AUC of all-cause death/cardiac rehospitalization predicted by plasma sST2 was 0.538(95%CI:0.388～0.689),the best threshold was 150.1 pg/ml,the sensitivity was 55.6%,the specificity was 51.3%;the AUC of all-cause death/cardiac rehospitalization predicted by plasma GDF-15 was 0.588(95%CI:0.433～0.742),the best threshold was 24.47pg/ml,and the sensitivity was 66.7%,the specifity was 53.8%;the AUC of all-cause death/cardiogenic readmission predicted by vWF+sST2+GDF-15+BNP was 0.725(95%CI:0.620-0.829).Conclusion:(1)Compared with HFrEF group,HFpEF group is older,more female,and more complicated with coronary heart disease,hypertension and atrial fibrillation.(2)BNP concentration in HFpEF group was lower than that in HFrEF group,and BNP might be more valuable for HFrEF patients.(3)The levels of vWF,sst2,GDF-15 and BNP in HFpEF patients were significantly higher than those in healthy people,which were significantly related to the severity of heart function in HFPEF and HFrEF patients,and could be used as a new biomarker for the severity of heart failure;vWF,sST2 and GDF-15 in plasma could be used as a supplement for BNP diagnosis of HFpEF,The combination of vWF,sst2,GDF-15 and BNP can improve the diagnostic value of HFpEF patients compared with BNP alone.(4)The levels of vWF,sst2,GDF-15 and BNP in plasma have a strong predictive and guiding significance for the risk of all-cause death and cardiogenic readmission in HFpEF patients,which can be used as a powerful supplement for BNP to evaluate the prognosis of HFpEF patients,and their combined application can greatly improve the evaluation ability for the severity of HFpEF patients and the prognosis of cardiovascular event risk,as well as for the prognosis of HFpEF patients The concentration of vWF,sST2 and GDF-15 in plasma is a new biomarker with potential research value for HFpEF patients,even more than the traditional recognized marker BNP. |
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