Correlation Of Plasma Ceramide And Sphingosine-1-phosphate Levels With Cardiac Function And Prognosis In Patients With Chronic Heart Failure

Objective:1.To analyze the changes of plasma Ceramide(Cer)and Sphingosine-1-phosphate(S1P)levels in patients with chronic heart failure(CHF)and their correlation with cardiac function.2.To explore the relationship between the levels of plasma Ceramide,S1P and the prognosis of patients with CHF.Methods:92 patients with chronic heart failure(CHF)treated in the second Hospital of Shanxi Medical University from January 2021 to June 2021 were selected as CHF group.According to the cardiac function classification standard of New York Heart Association(NYHA),CHF patients were divided into three groups:22 cases in gradeⅡgroup,34cases in gradeⅢgroup,and 36 cases in gradeⅣgroup.In addition,34 patients without heart failure hospitalized in the same period were selected as the control group.Collecting clinical data of all subjects,such as gender,smoking history,history of hypertension,history of diabetes,age,BMI,ALT,AST,Cr,TC,TG,HDL,LDL,Hb Alc,BNP,etc.Plasma Ceramide and Sphingosine-1-phosphate levels were detect by ELISA.Echocardiography was used to measure Left ventricular ejection fraction,Left ventricular end-diastolic diameter,Interventricular septal thickness,and Left ventricular posterior wall thickness and calculated Left ventricular mass index.The above indexes were compared between the CHF group and the control group,and the differences of plasma Ceramide,Sphingosine-1-phosphate,Left ventricular ejection fraction and Left ventricular mass index among different subgroups of CHF patients were analyzed.Pearson and Spearman correlation analysis were used to analyze the correlation between plasma Ceramide and Sphingosine-1-phosphate and their respective relationship with Left ventricular ejection fraction,left ventricular mass index and NYHA classification in CHF patients.According to the occurrence of major cardiovascular adverse events within6 months after discharge from hospital,CHF patients were divided into two groups:67cases in good prognosis group and 25 cases in poor prognosis group.The clinical data of the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of poor prognosis in patients with CHF.The value of plasma Ceramide,Sphingosine-1-phosphate and their ratio in predicting poor prognosis of patients with CHF was analyzed by receiver operating characteristic curve.Results:1.Compared with the control group,the age and plasma levels of AST,BNP were higher,while the plasma levels of TC,TG,HDL were lower in the CHF group(P<0.05).However there was no significant difference in male proportion,smoking history,prevalence rate of hypertension,prevalence rate of diabetes,BMI and plasma ALT,Cr,LDL,Hb Alc levels between the two groups(P>0.05).2.Compared with the control group,the plasma Ceramide level and LVMI value were higher,while the plasma S1P level and LVEF value were lower in the CHF group(P<0.05).3.Compared with gradeⅡgroup,the Ceramide level and LVMI value of the gradeⅢgroup were higher,the LVEF value was lower,the Ceramide level and LVMI value of the gradeⅣgroup were higher,and the S1P level and LVEF value were lower.Compared with gradeⅢgroup,the Ceramide level and LVMI value of the grade IV group were higher,and the S1P level and LVEF value were lower(P<0.05).4.Pearson and Spearman correlation analysis showed that there was a negative correlation between plasma Ceramide and S1P levels in patients with CHF(r_s=-0.498,P<0.05),a negative correlation between plasma Ceramide level and LVEF value(r=-0.439,P<0.05),but a positive correlation with LVMI value and NYHA classification(r_s=0.354,0.488,P<0.05).And plasma S1P level was positively correlated with LVEF value(r_s=0.246,P<0.05),but negatively correlated with LVMI value and NYHA classification(r_s=-0.463,-0.372,P<0.05).5.Compared with the group with good prognosis,the levels of plasma HDL and S1P were lower,and the levels of plasma Ceramide and LVMI were higher in the group with poor prognosis(P<0.05).There was no significant difference in male proportion,smoking history,prevalence rate of hypertension,prevalence rate of diabetes,age,BMI,LVEF and plasma levels of ALT,AST,Cr,TC,TG,LDL,Hb Alc and BNP between the two groups(P>0.05).6.Multivariate Logistic regression analysis showed that the decrease of plasma HDL and S1P levels and the increase of plasma Ceramide level were independent risk factors for poor prognosis in patients with CHF(OR=0.065,0.993,1.033,P<0.05).7.The results of ROC curve analysis showed that the area under the ROC curve of plasma Ceramide,S1P and their ratio to predict poor prognosis in patients with CHF were 0.829(95%CI:0.738-0.921),0.800(95%CI:0.705-0.895),0.871(95%CI:0.795-0.947).All of them have certain predictive value(P<0.05).The predictive value of Ceramide/S1P ratio was higher.Conclusion:1.The level of plasma Ceramide in patients with CHF was increased,which was negatively correlated with LVEF and positively correlated with LVMI and NYHA Classification.The level of plasma S1P was decreased,which was positively correlated with LVEF and negatively correlated with LVMI and NYHA Classification.There is a negative correlation between Ceramide and S1P,and the change of their levels can reflect the severity of cardiac function in patients with CHF.2.The increase of plasma Ceramide level and the decrease of HDL and S1P level were independent risk factors for poor prognosis in patients with CHF.The combined detection of Ceramide and S1P can be used as biomarkers to predict poor prognosis in patients with CHF and has certain guiding significance for early intervention and treatment in patients with CHF.