| Background and ObjectiveAcute myocardial infarction(AMI),one of the diseases currently affecting human survival,has been widely studied,and in recent years,studies on the conversion of energy metabolism in cardiac myocytes after damage have become increasingly sophisticated,in which ketone body metabolism can improve cardiac myocyte metabolism and reduce myocardial oxygen consumption has received widespread attention,in which the main component of ketone bodies,The role of β-hydroxybutyric acid in myocardial infarction has not been clearly concluded.Therefore,it is important to investigate the effect of β-hydroxybutyric acid on the prognosis of patients with acute myocardial infarction combined with cardiac insufficiency.Data and MethodsThis is a single-center retrospective observational study.Patients with acute myocardial infarction complicated with heart failure admitted to a grade-III hospital from January 1,2019 to December 31,2022 were continuously selected to collect demographic characteristics,laboratory indicators and other relevant information.According to whether the β-hydroxybutyric acid was higher than the normal upper limit of the laboratory,the group was divided into β-hydroxybutyric acid increased group and non-increased group.Baseline analysis was performed on the data between the two groups.The t test was used when the measurement data complied with normal distribution,and the non-parametric rank sum test was used when the measurement data did not comply with normal distribution.Chi-square test or fisher exact test were used for categorical variables.Spearman correlation analysis and Kendall correlation analysis were conducted between β-hydroxybutyric acid and other variables to analyze the reasons for the rise of β-hydroxybutyric acid,and the confounding factors were excluded by linear regression equation.The main outcome of the study was the improvement of cardiac function,which was defined as the improvement of cardiac function with NT-proBNP decreasing rate>30%in hospital.The secondary outcome was the occurrence of Major adverse cardiovascular and cerebrovascular events(MACCE)during the patient’s hospitalization.Baseline variables affecting cardiac function improvement and MACCE were selected for univariate Logistic analysis,and variables with P value<0.1 were included in multivariate Logistic regression model for analysis,to explore independent risk factors affecting cardiac function improvement and MACCE in patients with acute myocardial infarction complicated with heart failure.Odds Ratio(OR)and 95%Confidence Interval(CI)were used as indicators to measure the outcome,and P<0.05 was considered to be statistically significant.The ROC curve(receiver operating characteristic curve)was used to analyze the significant factors in the multi-factor Logistic regression equation,and to evaluate whether these factors can be used as effective indicators to evaluate the improvement of cardiac function after acute myocardial infarction.Youden index and area under the curve were used as parameters to evaluate the prediction effect of the curve.Results(1)A total of 260 patients were included in this study,of which 155 patients had elevated β-hydroxybutyrate.Compared with the non-elevated group,the plasma levels of CK-MB,cTnI and Gensini scores in patients with acute myocardial infarction complicated with cardiac insufficiency in the elevated β-hydroxybutyric acid group were higher.There was also a higher proportion of patients in the beta-hydroxybutyric acid group using neocytokines and diuretics than in the non-elevated group.(2)By linear regression equation test,the increase of β-hydroxybutyric acid was correlated with EF[unstandardized coefficient:-4.575,P<0.01,95%CI:(-5.769,3.381)],CK-MB[(unstandardized coefficient:0.006,P<0.05,95%CI(0.004,0.007)]and Gissiniss score[(unstandardized coefficient:0.006,P<0.05,95%CI(0.002.0.01)].(3)Plasma levels of CK-MB and β-hydroxybutyric acid were higher and the age was younger in patients with acute myocardial infarction and heart failure who achieved improved cardiac function compared with those who did not improve cardiac function.Patients with MACCE were older than those without MACCE,and there was no difference in beta-hydroxybutyrate between the two groups.(4)After multivariate Logistic regression test,elevated β-hydroxybutyrate[OR:2.517,95%CI(1.394,4.597),P=0.002]was an independent risk factor for cardiac function recovery in patients with acute myocardial infarction complicated with heart failure.Age and coronary artery disease were also independent factors affecting the improvement of cardiac function.Increased β-hydroxybutyric acid had no effect on the occurrence of MACCE.Age[OR:1.044.95%CI(0.998,1.096).P=0.007]was an independent risk factor for the occurrence of MACCE in patients with acute myocardial infarction complicated with heart failure.ROC curve verified that β-hydroxybutyric acid had predictive value of 0.61 area under the curve for short-term cardiac function prognosis in patients with acute myocardial infarction complicated with heart failure.Conclusion1.In patients with acute myocardial infarction complicated with heart failure,βhydroxybutyrate level was significantly correlated with myocardial damage.2.In patients with acute myocardial infarction complicated with heart failure,plasma beta-hydroxybutyric acid was an independent protective factor for short-term improvement in cardiac function,but had no significant effect on the occurrence of MACCE during hospitalization. |
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