The Level And Clinical Significance Of Plasma CMyBP-C In Chronic Heart Failure Patients

Background and purposeChronic Heart Failure(CHF)is agroup of intricate clinical syndrome result from abnormal changes in the structure or function of the heart,which make ventricular systolic or diastolic dysfunction.It is mainly manifested by dyspnea,fatigue and fluid retention(pulmonary congestion,systemic congestion and peripheral edema),which is the serious manifestation or terminal stage of various heart diseases.The mortality rate and re-hospitalization rate is high.With the aggravation of Chinese aging population,the incidence rate of various chronic diseases such as coronary atherosclerotic cardiopathy,hypertension and diabetes has been increased year by year.The improvement of medical level has prolonged the lifetime of patients with heart disease,meanwhile,leading to the rising incidence of CHF in China.This greatly affects the quality of life of the elderly and lead to huge economic pressure and medical costs to the society.The assessment and management of CHF relies on accurate risk stratification and early identification of poor prognosis in high-risk CHF patients.The widespread use of biomarkers can clarify the treatment strategies for different subgroups of CHF patients,meanwhile minimizing the occurrence of potential adverse reactions.B-type natriuretic peptide(BNP)or N-terminal pro-BNP(NT-proBNP)are commonly used clinically to diagnose and predict the prognosis of CHF.Combined utilization of multiple biomarkers may be the future development direction.Therefore,it is one of the research directions to search for more biomarkers related to the diagnosis and prognosis of CHF.Existing research at home and abroad shows that cardiac Myosin Binding Protein-C(cMyBP-C)play a crucial part in the process of cardiac shrink and diastole,which may show a state of high expression when the occurrence of myocardial injury,which is closely related to coronary heart disease、hypertension、hypertrophic cardiomyopathy and other cardiovascular disease.It also can be used as one of the early specific biomarkers of the diagnosis of myocardial infarction.Lack of expression and dysfunction of phosphorylation of cMyBP-C can lead to cardiac contraction or relaxation dysfunction,which may be related to the occurrence and development of CHF.However,there are few studies about cMyBP-C on the diagnosis and prognosis evaluation of CHF patients.This study analyzed the difference of the plasma level of eMyBP-C among CHF group patients and normal control group patients and the CHF group patients before and after treatment and the correlation of plasma cMyBP-C and index associated with heart failure,and explored the value of cMyBP-C in CHF diagnosis and disease assessment.This study also discussed the value of cMyBP-C in predicting the occurrence of major adverse cardiovascular events(MACE)in 1 year in patients with CHF,providing a new idea in diagnosis、disease evaluation and prognosis assessment for CHF patients.Materials and MethodsA total of 89 patients(49 males and 40 females)with chronic heart failure who hospitalized in the First Affiliated Hospital of Zhengzhou University from October 2018 to January 2019 were selected as heart failure group,and another 30 healthy patients(18 males and 12 females)recruited from the outpatient physical examination center were selected as the control group.In the heart failure group,the patients were divided into NYHA Ⅱ group(n=19)(21%),NYHA Ⅲ group(n=40)(45%)and NYHAⅣ group(n=30)(34%)according to the New York Heart Association(NYHA)classification.The general clinical data of all subjects on admission were collected,and the plasma cMyBP-C levels of all subjects on admission and the heart failure group after treatment was tested.Left ventricular ejection fraction(LVEF)、left ventricular fractional shortening(LVFS)and E/A ratio were measured by color doppler ultrasound echocardiography.After leaving hospital,89 patients with heart failure were followed up for 1 year,and the incidence of major adverse cardiovascular events was recorded.According to the follow-up results,they were divided into MACE group and non-MACE group.The data were statistically analyzed by SPSS24.0 and GraphPad Prism 7.0 statistical software,the difference of serum cMyBP-C levels among groups was compared.Pearson and Spearman correlation analysis was used to analyze the relationship between plasma cMyBP-C level in the heart failure group and heart failure related indicators.Cox proportional risk regression model was constructed to analyze the influencing factors of MACE in the heart failure group within 1 year.And receiver operating characteristic(ROC)curve was drawn to evaluate the value of cMyBP-C in predicting recent MACE in CHF patients.Results1.Compared with the control group at admission,the plasma levels of cMyBP-C in the heart failure group were significantly relatively higher[(137.07±44.44)ng/ml vs(29.29±10.37ng/ml](P<0.01).Compared with the heart failure group at admission,the plasma levels of cMyBP-C in the heart failure group after treatment were significantly relatively lower[(84.67±37.98ng/ml vs(137.07±44.44ng/ml](P<0.01).2.In the heart failure group,the mean plasma level of cMyBP-C in NYHA Ⅳgroup[(179.59±30.26)ng/ml]was significantly higher than that in NYHA Ⅲ group[(133.83±28.63)ng/ml]and NYHA Ⅱ group[(86.68±23.51)ng/ml].The differences were statistically significant(P<0.01).3.Pearson correlation analysis showed that level of plasma cMyBP-C was positively correlated with NT-proBNP(r=0.711,P<0.01),and negatively correlated with EF,FS and E/A ratio in the heart failure group(r=-0.659,P<0.01;r=-0.457,P<0.01;r=-0.478,P<0.01).Spearman correlation analysis showed that level of plasma cMyBP-C was positively correlated with NYHA grade in the heart failure group(r=0.756,P<0.01).4.The follow-up results showed that the mean plasma levels of cMyBP-C in the MACE group were significantly higher than those in the non-MACE group,both before and after treatment.After treatment,the mean decrease of plasma cMyBP-C in the MACE group was significantly lower than that in the non-MACE group(P<0.01).5.Cox regression analysis showed that plasma cMyBP-C level at admission(HR=1.024,95%CI:1.001～1.048,P=0.044)was an independent risk factor for the occurrence of MACE in CHF patients.6.The ROC results showed that the area under the ROC curve of plasma cMyBP-C level on admission to predict the recent occurrence of MACE in CHF patients was 0.805(95%CI:0.688～0.922).The cut-off value was 154.71 ng/ml,and the predictive sensitivity was 84.2%,and the specificity was 74.1%.ConclusionsThe expression of cMyBP-C in patients with chronic heart failure is increased,and it is closely related to the severity of the disease,and it is an independent risk factor for the recent occurrence of MACE,which provides a new direction for the diagnosis,disease evaluation and prognosis evaluation of chronic heart failure.