| Objectives To evaluate the diagnostic and prognostic value of plasma mid-regional proatrial natriuretic peptide(MR-proANP)in patients with heart failure complicated with atrial fibrillation.Methods A total of 207 patients with chronic heart failure hospitalized in the Department of Cardiovascular Medicine of Hebei General Hospital from December 2019 to July 2021 were enrolled,and 57 patients without HF or AF diagnosis but with coronary heart disease and diabetes mellitus were included in the control group.HF was divided into sinus rhythm heart failure(HF-SR)group and heart failure combined with atrial fibrillation(HF-AF)group according to prehospital AF.The basic data of patients in the three groups were compared to explore the correlation between MR-proANP and clinical indicators.The diagnostic and prognostic value of MR-proANP in HF-AF was evaluated by ROC curve.All HF patients were followed up for 6 months,and HF readmission or cardiac death was used as the end point event.K-M survival curve was used to analyze the survival status of patients with HF-AF at different MR-proANP concentrations.Univariate and multivariate Cox regression analysis of prognostic factors in patients with HF-AF/HF.This study was reviewed by the Ethics Committee of Hebei General Hospital,and approved by the Medical Ethics Committee No.22,2022 Scientific Research Review.Results 1 In comparison of baseline data of the three groups,there were statistical differences in age,left atrial diameter,MR-proANP and other indicators between the HFAF group and the HF-SR group.2 In the analysis of heart failure subgroups classified by ejection fraction,MR-proANP was 483.5(303.0,687.3)pg/mL in the HFr EF group and 442(269.3,686.0)pg/mL in the HFmr EF group.MR-proANP in HFp EF group was 474.0(362.0,624.0)pg/mL,and there was no statistical difference in the overall distribution of MRproANP among the three groups(H=0.19,P=0.909).3 In correlation analysis,MR-proANP was significantly correlated with age,BMI,GFR,LVEF,LAD,ESD,EDD,c TNT,uric acid,creatinine and NT-proBNP(P<0.05).4 ROC diagnostic analysis showed that in patients with HF-AF,the area under the curve of MR-proANP was 0.662(95%CI: 0.588-0.736,P<0.001)for the diagnosis of HF-AF,and the sensitivity and specificity of MR-proANP for the diagnosis of HF-AF were 68.9% and 60.4%,respectively,in the HF-SR group as the control group.5 ROC prognostic analysis showed that there was no statistically significant difference in the predictive value of MR-proANP and NT-proBNP for the occurrence of endpoint events in HF-AF patients.6 In the survival analysis,HF-AF was divided into two groups according to the optimal cut-off value of the prognostic ROC curve of MR-proANP,and the relationship between MR-proANP level and the risk of end-point events in the HFAF group during the 6-month follow-up was compared.Survival analysis results showed that in the HF-AF group,patients with high MR-proANP(≥362pg/mL)had a higher risk of end-point events and a lower survival rate than patients with low MR-proANP(<362pg/mL)during the six-month follow-up period.Chi-square value of Log-rank test statistic is 14.424,P<0.001.In the patients with HF-AF,the occurrence of end-point events was taken as the dependent variable,and the factors P<0.2 in the univariate Cox proportional risk regression model were all included in the multivariate Cox proportional risk regression model as independent variables.The results showed that,Systolic blood pressure,MRproANP≥362pg/mL and NT-proBNP≥3070pg/mL were the influencing factors for the prognosis of patients with HF-AF(P<0.05).In HF patients,the occurrence of end-point events was taken as the dependent variable,and the factors P<0.2 in univariate Cox proportional risk regression model analysis were all included in multivariate Cox proportional risk regression model analysis as independent variables.The results showed that,systolic blood pressure,aspartate aminotransferase,urea,glomerular filtration rate,MR-proANP≥454pg/mL,NT-proBNP≥4330pg/mL were the influencing factors for the prognosis of patients with HF-AF(P<0.05).Conclusions 1 Plasma MR-proANP is a stable biomarker and an indicator of atrial size and pressure.In patients with HF-AF,MR-proANP has certain auxiliary diagnostic and prognostic value.2 Compared with the control group and the HF-SR group,the plasma concentrations of LAD,creatinine and MR-proANP in HF-AF patients were significantly increased.MR-proANP was significantly correlated with LAD,GFR,creatinine and NTproBNP(P<0.05).3 The specificity of MR-proANP in the differential diagnosis of HF-AF and HF-SR is better than that of NT-proBNP,and the sensitivity is up to 60.4%.Plasma MRproANP has the value of differential diagnosis for HF-AF and HF-SR.4 Baseline plasma MR-proANP≥362pg/mL,NT-proBNP≥3070pg/mL and systolic blood pressure can reflect the risk of short-term end point events in patients with HF-AF.Baseline plasma MRproANP≥454pg/mL,NT-proBNP≥4330pg/mL,aspartate aminotransferase,glomerular filtration rate,systolic blood pressure and urea can reflect the short-term risk of end-point events in HF patients.Figure 4;Table 11;Reference 101... |
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