| Objective1.To compare the demographic,clinical,echocardiographic and laboratory characteristics among heart failure patients with reduced,mid-range and preserved ejection fraction.2.To explore the relationship between biomarkers(plasma IGF-1level,IGFBP-1 level,and IGFBP-1/IGF-1 ratio)and heart failure subgroups,NYHA functional classification,and plasma NT-proBNP level.MethodsFrom October 2018 to October 2019,patients with acute heart failure were enrolled consecutively in the Department of Cardiology,Second Hospital of Tianjin Medical University,and the baseline data were collected.The demographic,clinical,laboratory and echocardiographic characteristics of patients with heart failure with reduced ejection fraction,median ejection fraction and preserved ejection fraction were compared and analyzed.Blood samples were collected within 24 hours of admission,and the levels of plasma IGF-1 and IGFBP-1 were measured.The relationship between the plasma biomarker IGF-1 level,IGFBP-1 level,IGFBP-1/IGF-1 ratio,and heart failure classification,heart failure severity(NYHA functional classification),plasma NT-proBNP level was analyzed.Results1.Comparison of clinical data of patients with three types of heart failure.A total of 143 patients with acute heart failure were enrolled,including 51 patients with reduced ejection fraction(HFrEF),27 patients with mid-range ejection fraction(HFmrEF),and 65 patients with preserved ejection fraction(HFpEF).1.1 Demographic characteristics.Males in the HFpEF group was significantly lower than that in the HFrEF group and the HFmrEF group(P<0.001).There were significant differences in mean systolic blood pressure(P=0.02)and diastolic blood pressure(P=0.009)at admission among the three groups.1.2 Clinical features.In terms of clinical history,there was significant difference in the proportion of myocardial infarction among the three groups(P<0.001).The proportion of patients with myocardial infarction history in HFrEF group was 56.9%(29 cases),which was higher than that of HFmrEF(6 cases,22.2%)and HFpEF groups(13 cases,20%).In terms of clinical medication,statistical difference were found in application proportion of angiotensin system inhibitors,aldosterone receptor antagonists,digoxin,diuretics,and calcium channel blocker.1.3 Echocardiographic parameters.The ejection fraction among three types of heart failure was statistically different(P<0.001).There was a progressive increase in left ventricular end-systolic diameter and end-diastolic diameter from HFpEF group to HFmrEF group to HFrEF group.The interventricular septum thickness(IVS)and the left ventricular posterior wall thickness(LVPW)of HFpEF group and HFmrEF group were significantly higher than that of HFrEF group,and the difference was statistically significant.All patients with heart failure had a high E/ E’ ratio,while E/ E’ ratio in the HFrEF group and HFmrEF group were significantly higher than that in HFpEF group.1.4 Laboratory parameters.Laboratory parameters were analyzed and compared among the three types of heart failure.The NT-proBNP in HFrEF group and HFmrEF group was significantly higher than that in HFpEF group(P=0.035).The red blood cell distribution width-CV(RDW)in HFrEF group was was significantly higher than that in HFmrEF group and HFpEF group(P=0.004).2.The value of plasma biomarker IGF-1 level,IGFBP-1 level and IGFBP-1/IGF-1 ratio in patients with heart failure.2.1 Plasma IGF-1 levels,IGFBP-1 levels and IGFBP-1/IGF-1 ratio in patients with different types of heart failure.No statistical difference were found in plasma IGF-1 level,IGFBP-1level and IGFBP-1/ IGF-1 ratio among three groups.2.2 Plasma IGF-1 level,IGFBP-1 level and IGFBP-1/IGF-1 ratio in patients with different cardiac function(NYHA).With the aggravation of cardiac function(NYHA),the plasma IGFBP-1 level increased,and the increase in patients with class IV cardiac function was more prominent(P=0.048).2.3 Relationship between plasma IGF-1 level,IGFBP-1 level and IGFBP-1/IGF-1ratio and plasma NT-proBNP.Plasma IGFBP-1 level(r = 0.348 P<0.001)and IGFBP-1/IGF-1 ratio(r = 0.335P<0.001)were significantly correlated with NT-proBNP level.Conclusions1.Heart failure patients with reduced,mid-range and preserved ejection fraction were significantly different in gender,history of myocardial infarction,blood pressure at admission,left ventricular end-diastolic diameter,interventricular septum thickness,clinical medication(including angiotensin receptor antagonist,aldosterone receptor antagonist,digoxin,calcium receptor antagonist,diuretic),NT-proBNP and so on.2.There was significant difference in blood RDW levels among the three types of heart failure.3.There was no significant difference in plasma IGF-1 level,IGFBP-1 level and IGFBP-1/IGF-1 ratio among the three types of heart failure.4.With the aggravation of heart failure(according to NYHA functional classification),the plasma IGFBP-1 level increased.5.Plasma IGFBP-1 level and IGFBP-1/IGF-1 ratio were significantly correlated with NT-proBNP level. |
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