| Groundback and Objective The pathophysiology mechanisms in chronic heart failure mainly include haemodynamic abnormality, myocardial damage and left ventricular remodeling, neuroendocrine activation. The three reciprocal causation form vicious cycle and worsen heart function. Up to now, the pathophysiology mechanism of chronic heart failure is still complex and not fully defined. We found that, in addition to the three main mechanisms, maybe there exist intimate correlation to kinds of active material in human body with heart failure. According to compared with control group, we observed the change of plasma levels of B-type natriuretic peptide, C-reactive protein, D-dimer, endothelial-1, fibrinogen in patients with chronic heart failure and analyzed correlation between New York heart association class and the parameter measured by echocardiography.Methods 116 patients were enrolled in the study including 20 cases(males 11, 55.00±16.06 years; females 9,46.33±16.50 years) without any disease as control group(named Group 1), 21 cases (males 10,64.20±7.01 years;females 11, 69.91±10.19 years)with heart disease but non-dysfunction as heart disease group(named Group 2), 75 cases (males 31,68.26±13.39 years;females 44,70.75±9.89 years)with heart disease and dysfunction as chronic heart failure group(named Group 3,4,5 respectively). We measured B-type natriuretic peptide with Triage Analyzer produced by BIOSITE Co.ltd Americia, C-reactive protein with immunoturbidimetry assay, endothelin-1 with radioimmunoassay, D-dimer and fibrinogen with enzyme-linked immunoassay. This study is to do a comparison of B-type natriuretic peptide, C-reactive protein, D-dimer, endothelial-1 and fibrinogen concentration inter-groups containing Group 1 (n=20), Group 2(n=21) and Group 3, 4, 5(n=75) and echocardiograms were detected in all patients. Correlation between B-type natriuretic peptide, C-reactive protein, D-dimer, endothelial-1, fibrinogen concentration was also analyzed in every group. To observe cardiaovascular events incidence rate, chronic heart failure group was followed for six months.Results(1) Plasma B-type natriuretic peptide concentrations in Group1, Grup2, Group3, Group4, Group5 was 18.59±12.09 pg/ml , 80.88±59.99 pg/ml ,316.20±134.58pg/ml,680.47±397.3pg/ml,1203.46±528.66pg/ml respectively and increased in Group3, Group4, Group5 compared with Group1 and Grup2 significantly(P<0.05). B-type natriuretic peptide concentration had significantly differences between Group3, Group4, Group5 and was positively correlation with NYHA class(r=0.843, P<0.05) , negatively correlation with left ventricle ejection fraction (r= - 0.845,P<0.05) in whole 5 group.(2) Compared with group1 and group2, C-reactive protein, D-dimer, endothelial-1, fibrinogen concentrations increased and existed significantly difference between Group3, Group4 and Group5. The plasma level of C-reactive protein, D-dimer, endothelial-1, fibrinogen increased according to NYHA cardiac class and were significance correlated with New York heart association class. The spearman coefficient of correlation of C-reactive protein, D-dimer, endothelial-1, fibrinogen is 0.787, 0.770, 0.597, 0.644 respectively(P<0.05).(3) Left atrial diameter and left ventricle end-diastolic diameter increased in Group 3,4,5 compared with Group1 and Grup2(P<0.05)while left ventricle ejection fraction and fraction shortening were lower than in Group1 and Grup2 (P<0.05). The scale of left atrial diameter and left ventricle end-diastolic diameter is gradually increasing as New York heart association class upgraded while left ventricle ejection fraction and fraction shortening is gradually decreasing.(4) Stepwise multivariate regression analysis was used with 18 variables, included C-reactive protein, D-dimer, endothelin-1,fibrinogen,year, heart rate, red blood cell count, white blood cell count, haemoglobin, blood glucose, blood uric acid, total cholesterol, triglyceride, high density lipoprotein,low density lipoprotein, body mass index as independent variable and the B-type natriuretic peptide as dependent variable. We founded that only C-reactive protein, D-dimer and fibrinogen entered the regression equation (t=5.780, 5.369, 4.519, P<0.05, respectively).(5) By Receiver operating characteristic curve we founded that the area under the cure was 0.741, CI(0.647,0.835), and the sensitivity was 86.1%, speciality was 36.2% when the B-type natriuretic peptide cutoff was 83.75 predicting cardiovascular events. Conclusion(1) The level of B-type natriuretic peptide is increasing in patients with chronic heart failure and obviously related with New York heart association class. The more upgraded New York heart association class ,the more high the level of B-type natriuretic peptide. The level of B-type natriuretic peptide can reflex cardiac status diagnosing chronic heart failure and serve as an index to evaluate curative effect and prognosis on patients with chronic heart failure.(2) There is the non-special inflammatory lesion in patients with chronic heart failure. Increased level of the C-reactive protein suggests there is a non-special inflammatory lesion, which correlate with bad cardiac function closely.(3) Patients with chronic heart failure show evidence of hypercoagulability and fibrinolysis activation. The level of D-dimer and fibrinogen increased in patients with chronic heart failure are related with severe degree of heart failure intimately.(4) Chronic heart failure has an important impact on abnormality of endothelial cell function. The concentratin of ET-1 in patients with chronic heart failure is increased and related to New York heart association class.(5) B-type natriuretic peptide, C-reactive protein, D-dimer, endothelial-1, fibrinogen exist inter-restriction and interference and maybe participate in pathophysiological process of chronic heart failure.
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