| Objective:The levels of serum homocysteine and NT-proBNP were measured in patients with chronic heart failure secondary to coronary heart disease(abbreviated as heart failure)to approach the correlation between HCY and the severity of heart failure(including cardiac function classification,LVEDD,LVEF and NT - proBNP) . Meanwhile the interventional treatment of folic acid and vitamin B6,B12 were given to the heart failure patients to observe weather lowing the level of HCY could improve the ventricular remodling and had benefit to prevent or treat the heart failure after the short-term therapy.Methods:All 57 patients with chronic heart failure secondary to coronary heart diseases(abbreviated as heart failure group)were hospitalized in the Medical Department of Cardiology of the Forth People's Hospital of Jinan from the time 2007.1 to 2008.2 consecutively .All heart failure patients were divided into three subgroups according to NYHA cardiac function classification,that is NYHAⅡ-Ⅳ(abbreviated as coronary heart failureⅡ,Ⅲ,Ⅳgroups).Twenty patients at the same period in hospital who were diagnosed as stable angina pectoris but not heart failure ones were selected as coronary heart disease control group(abbreviated as CHD control group).And 20 healthy subjects after examination served as the control group(abbreviated as healthy control group).5ml fast blood sample were taken from each patient, and serum of them were separated by centrifugation to measure the levels of HCY,NT-proBNP and some biochemical indexes such as serum glucose,serum lipids,renal function and so on . Left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction (LVEF) of all patients were determinated by echocardiogram when they were in hospital. 3ml fast blood sample were taken from the healthy subjects,and serum of them were also separated by centrifugation to measure the levels of HCY and NT-proBNP.Note the general information of all subjects.Collect all the data and analysis the indexes to observe the correlation between serum HCY and NYHA classification,NT-proBNP,cardiac function.At the same time observe the changes of serum HCY and NT-proBNP after being treated by folic acid and vitamin B6,B12 for 2weeks.All of these data underwent statistics test by SAS 8.12 software. Measurement data were showed as x±s,P<0.05 should be thought as having significant difference in statistics. Results:1. The prevalence rate of HHCY was higher in chronic heart failure group than in stable angina pectoris group and the healthy control group.Among the total,prevalence rate in heart failure group was 56.1%,in angina pectoris group was 32.0% and in healthy group was 15.0%.There were significant difference in tatistics in the three groups(p<0.01).2. The serum HCY in patients with chronic heart failure disease(19.66±5.39mmol/L)were higher than in stable angina pectoris patients(16.66±2.51 mmol/L)and both higher than in the healthy peopl(e9.53±3.17 mmol/L);the serum level HCY in the three groups had significant difference in tatistics (p<0.05).3. In heart failure group the serum HCY were increased with the NYHA cardiac function classification,in the NYHAⅡ,Ⅲ,Ⅳgroup were 17.18±5.33 mmol/L,19.86±5.72 mmol/L,22.75±5.02 mmol/L respectively,the level of HCY in the three groups had significant difference in statistics (p<0.05).In heart failure group NT-proBNP were increased with the NYHA cardiac function classification,in the NYHAⅡ,Ⅲ,Ⅳgroup were 242.95±211.18pg/ml,1211.41±840.61 pg/ml,11000.27±13105.17 pg/ml respectively;the level NT-proBNP in the three groups had significant difference in statistics (p<0.05).It was showed that serum HCY and NT-proBNP were determined with positive linear correlation by the linear correlation analysis(r=0.583,P <0.05).4. In heart failure group, the serum HCY and EF were determined with negative linear correlation(r=-0.482,P <0.05);the serum HCY and LVEDD were determined with negative linear correlation (r=0.561,P <0.05).5. After treated with folic acid,vitaminB6 and B12 ,the levels of HCY and NT-proBNP were both decreased .It had significant difference in statistics before and after treatment(p<0.01). It also had significant difference in statistics between the routine treatment group and the folic acid treatment group(p<0.05) after the short-term therapy.Conclusion: 1. There are universal existence of HHCY in chronic heart failure secondary to coronary heart disease which are higher than in stable angina pectoris patients and the healthy people.The serum HCY in patients with chronic heart failure secondary to coronary heart disease are higher than stable angina pectoris patients,and both of them are higher than the healthy people;which means that HCY are associated with heart failure and maybe one of the independent risk factors of heart failure.2. The levels of HCY and NT-proBNP are increased with the NYHA cardiac function classification in the heart failure patients,and they are determined with linear correlation,which means that the level of HCY is increased with the severity degree of the cardiac function and the serum HCY may participates in the development of heart failure.3. After treatment, both levels of HCY and NT-proBNP are decreased in the heart failure patients,which means that HCY will be decreased when the heart function becomes better.It seems to be related with the prognosis of heart failure .
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