| Objective: This study aimed to investigate the correlation between plasma periostin（POSTN）levels and myocardial fibrosis（MF）in patients with chronic heart failure（CHF）,and to further clarify the predictive value of plasma POSTN levels for adverse cardiovascular events in CHF patients.Methods: This study was a single-center,prospective study.A total of 49 patients with CHF who were hospitalized in the Heart Center of the First Hospital of Lanzhou University from March 2021 to September 2021 were selected as the observation group.All patients were determined by enzyme-linked immunosorbent assay（ELISA）for plasma POSTN levels.The structure and function of the patients’ hearts were evaluated by transthoracic echocardiography（TTE）and cardiac magnetic resonance（CMR）,and the included patients were divided into three groups according to the tertiles of plasma POSTN levels determined by ELISA.At the same time,a follow-up of 8.7±1.3 months was carried out,and healthy subjects who visited the Physical Examination Center of the First Hospital of Lanzhou University during the same period were selected as the control group,with a total of 31 cases.The past medical history,general condition,medication history,laboratory tests,imaging examinations,in-hospital CHF worsening,CHF rehospitalization,and cardiovascular death were collected from all participants,and the left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）and left ventricular ejection fraction（LVEF）were measured by TTE and CMR,and they were recorded respectively.Left atrial diameter（LAD）,left ventricle posterior wall thickness（LVPWT）and pulmonary artery main diameter were measured by TTE.Left ventricular myocardial mass（LVM）was measured by CMR,and left ventricular myocardial mass index（LVMI）was calculated（LVMI is the ratio of LVM to body surface area）.The differences in general data and plasma POSTN levels were compared between groups,and the correlation between plasma POSTN and MF,inhospital CHF worsening,CHF rehospitalization,cardiovascular death,LAD,LVEDV,LVESV,LVEF,LVM,LVMI and pulmonary artery main diameter were compared.Logistic regression analysis combined with ROC curve analysis were to evaluate the diagnostic efficacy of plasma POSTN levels and MF.The Kaplan-Meier method was used to determine the value of plasma POSTN levels in predicting the occurrence of composite endpoint events.The Bland-Altman method was used to evaluate the consistency of cardiac structure and function in CHF patients with TTE and CMR.Results:（1）Compared with the normal control group,the age,gender,body mass index（BMI）,systolic blood pressure（SBP）,counts of erythrocyte,hemoglobin,counts of leukocyte,counts of neutrophil,counts of lymphocyte,platelet distribution width（PDW）and creatinine（Scr）levels of the observation group had no statistical difference（all P>0.05）;（2）Compared with the normal control group,there were statistically differences in the systolic blood pressure（DBP）,heart rate（HR）,plasma POSTN level,neutrophil count/lymphocyte count ratio（NLR）,platelets,and fasting blood sugar（FBS）in the observation group（all P<0.05）.There were significant differences in Nt-pro BNP,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,total bilirubin（TBil）,uric acid（UA）,urea nitrogen（BUN）,homocysteine（Hcy）,LVEF,LAD,LVEDV,LVESV,LVPWT and the inner diameter of the main pulmonary artery（all P<0.001）;（3）After grouping the observation group according to the tertiles of plasma POSTN levels,there were 16 patients in the first tertile group,17 patients in the second tertile group,and 16 patients in the third tertile group.We found that atrial fibrillation（AF）,type 2 diabetes mellitus（T2DM）,Hcy,LAD,LVEDV-echo among the three groups were significantly different（all P<0.05）;（4）All patients in the observation group were followed up,and the composite endpoint event consisting of cardiovascular death,in-hospital CHF worsening,and rehospitalization due to CHF was used as the outcome indicator.During the followup,there were 3 cases of cardiovascular death,all of them were patients in the third tertile,but there was no statistical difference among the three groups（P>0.05）.There were 18 patients with worsening in-hospital CHF,and compared with the low-plasma POSTN group,the in-hospital CHF worsening in the high-plasma POSTN group increased,and the difference was statistically significant（P=0.015）.A total of 7patients were hospitalized due to CHF.Compared with patients with low plasma POSTN levels,the number of CHF readmissions showed an upward trend,but there was no statistical difference between the three groups（P=0.469）.There were 25 composite endpoint events consisting of cardiovascular death,in-hospital CHF worsening and rehospitalization due to CHF.The difference was statistically significant（P<0.001）;（5）Through the composite univariate Logistic analysis of the occurrence of composite endpoint events,it was found that plasma POSTN level（OR=1.015,95%CI=1.007-1.023,P<0.001）,fibrosis ratio（OR=1.127,95% CI=1.050-1.209,P=0.001）,NYHA class（OR=2.207,95%CI=1.064-4.578,P=0.034）,AF（OR=4.117,95%CI=1.168-14.504,P=0.038）,T2DM（OR=7.333,95%CI=1.403-38.333,P=0.018）,LVEF（OR=0.943,95%CI=0.898-0.991,P=0.019）and Nt-pro BNP（OR=0.943,95%CI=0.898-0.991,P=0.049）were risk factors for composite endpoint events in CHF patients.Multivariate Logistic regression analysis found that plasma POSTN level（OR=1.014,95%CI=1.002-1.026,P=0.026）,fibrosis ratio（OR=1.108,95%CI=1.001-1.226,P=0.048）,AF（OR=24.941,95%CI=2.387-260.575,P=0.007）were independent risk factors for composite endpoint events in CHF patients;（6）According to the ROC curve,the area under curve of plasma POSTN level for the diagnosis of MF was 0.784,and the optimal cutoff value was 30.2ng/m L;（7）Kaplan-Meier analysis was used to describe the composite endpoint events of patients with plasma POSTN levels.It was found that with the increase of plasma POSTN levels,the occurrence of composite endpoint events in CHF patients increased.（8）There was a significant correlation between TTR and CMR in the assessment of cardiac morphology and function（P<0.001）,and the Bland-Altman analysis indicated that TTE and CMR had good consistency in assessing cardiac structure and function in patients with CHF.Conclusion: Plasma POSTN level is increased in CHF patients,and its value is related to the degree of MF.It is a biomarker for the diagnosis of MF,and plasma POSTN is an independent risk factor for adverse cardiovascular events in CHF. |
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