Predictive Value Of Plasma CfDNA On Heart Failure After Myocardial Infarction During Hospitalization

Objectives:Studies have reported that plasma cell-free DNA(cf DNA)levels in patients with acute myocardial infarction are significantly increased,but whether cf DNA level can predict the occurrence of adverse cardiac event-heart failure after myocardial infarction during hospitalization,is still currently unclear.Therefore,the purpose of this study is to explore whether cf DNA can predict heart failure after myocardial infarction during hospitalization.Methods:In this study,we continuously enrolled 123 patients who were hospitalized in the Department of Cardiology,Hunan Provincial People’s Hospital from June 2020 to December 2020,who had acute myocardial infarction within 24 hours for the first time and needed to undergo percutaneous coronary intervention.2 cases of cerebral infarction,9 cases of tumor,1 case of sepsis,8 cases of death were excluded,and 103patients with acute myocardial infarction were finally included.According to the preoperative plasma cf DNA level of percutaneous coronary intervention,the cohorts were divided into two groups:a low-level cf DNA group and a high-level cf DNA group.The general clinical data,laboratory data such as myocardial enzymes,and tissue Doppler echocardiography data of the two groups of patients were collected.Enzyme-linked immunosorbent assay was used to detect the level of s ST2 in the two groups of patients.The first occurrence of heart failure after acute myocardial infarction was collected after admission.Pearson or Spearman correlation analysis was used to study the relationship between cf DNA and WBC,Cr,LDL-C,c Tn I,MYO,CK-MB,CRP,NT-pro BNP,s ST2 and other laboratory indicators,as well as LVEF,WMSI and other tissue Doppler echocardiographic parameters.Cox proportional hazard regression analysis and survival analysis were used to explore the predictive value of cf DNA in heart failure after myocardial infarction during hospitalization.Results:1.The plasma cf DNA levels of patients with acute myocardial infarction obey the normal distribution,with an average of 625ng/ml.Based on the average level,they were divided into two groups:a low-level cf DNA group(cf DNA≤625ng/ml)and a high-level cf DNA group(cf DNA>625ng/ml).There was no statistical difference between two groups in general clinical data and the parameters of cardiac color Doppler ultrasound.But we found that the plasma s ST2(P=0.026),TC(P=0.016),LDL(P=0.005)levels in the high-level cf DNA group were significantly higher than those of the low plasma cf DNA group.2.Plasma cf DNA level in all patients with acute myocardial infarction was positively correlated with Cr(r=0.202,P=0.040),LDL(r=0.212,P=0.032),WBC(r=0.246,P=0.013),and s ST2(r=0.295,P=0.003).Among them,cf DNA was mainly positive correlated with Cr(r=0.272,P=0.049),s ST2(r=0.296,P=0.031),and WBC(r=0.300,P=0.031)in the group with high levels of plasma cf DNA.3.With the first heart failure after acute myocardial infarction after admission as the endpoint event,survival analysis showed that the incidence of heart failure after acute myocardial infarction in the two groups with low and high levels of plasma cf DNA was 42%and 47.1%,respectively.The Log Rank method was used to test the difference in the"survival"distribution of the two groups of patients with high and low levels of plasma cf DNA.There was no significant difference in the distribution of"survival"between the two groups(X~2=0.478,P=0.489).4.Using Cox proportional hazard regression analysis to confirm whether plasma cf DNA,age,gender,BMI,CKD,Cr,BUN,MYO,c Tn I,CK-MB,NT-pro BNP,s ST2,WMSI,number of stents,hospital stay were the risk factors for heart failure after myocardial infarction during hospitalization.The results of univariate regression analysis showed that age,CKD,Cr,BUN,MYO,NT-pro BNP,WMSI,hospital stay were risk factors for heart failure after myocardial infarction during hospitalization(P<0.05).After further multivariate regression analysis and correction,the results showed that MYO(HR=1.002,P=0.004)and NT-pro BNP(HR=1.000,P=0.037),but not plasma cf DNA(HR=1.000,P=0.844),were independent risk factors for heart failure after myocardial infarction during hospitalization.5.The predictive power of cf DNA,s ST2,NT-pro BNP and MYO on heart failure after myocardial infarction during hospitalization was evaluated by ROC analysis.The results showed that MYO had the most sensitive predictive performance for heart failure after myocardial infarction during hospitalization[AUC=0.778,95%CI(0.666-0.867);P=0.0549],followed by NT-pro BNP for predicting heart failure after myocardial infarction during hospitalization[AUC=0.747,95%CI(0.632-0.842);P=0.0578],s ST2 is more sensitive in predicting heart failure after myocardial infarction during hospitalization[AUC=0.639,95%CI(0.518-0.748);P=0.0656],Plasma cf DNA has the lowest predictive power for heart failure after myocardial infarction during hospitalization[AUC=0.586,95%CI(0.465-0.700);P=0.0686].Conclusion:1.The plasma cf DNA level is positively correlated with s ST2 in acute myocardial infarction.2.Plasma cf DNA is not an independent risk factor for heart failure after myocardial infarction during hospitalization.