The Observation Between MMP-9 And Heart Failure With Normal Ejection Fraction

Background:In patients with chronic heart failure, the morbidity and prognosis of heart failure with normal ejection fraction (HFNEF) is not better than that of in heart faiulre with reduced ejection fraction(HFREF). Currently,the diagnosis and treatment of HFREF are clear, but the characteristics of epidemiology and pathophysiology, diagnostic criteria, treatment principles, prognosis in HFNEF are still in controversial, especially there is few observation about the prognosis about HFNEF.Objective:To observe the differences of general information, etiology, serum matrix metalloproteinase-9 (MMP-9), laboratory indicators of routine examination and echocardiographic indicators between HFNEF and HFREF; To observe the correlation of N-terminal brain natriuretic peptide (NT-ProBNP) and MMP-9; To find out the following with the prognosis of HFNEF and HFREF,to find out the prognostic indicators in HFNEF.Methods:A total of 178 patients of chronic heart failure who were in department of cardiology of Tianjin Mendical University from February 2009 to Sepertember 2009 were selected, venous blood samples of patients were taken to measure MMP-9, NT-ProBNP, hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC), potassium (K), sodium (Na), chlorine (C1), calcium (Ca), creatinine (Cr), uric acid (UA), C-reactive protein(CRP) and other indicators, doppler echocardiography were measured after admission.The patients were divided into two groups according to "ESC 2007 Association consensus for the diagnosis of heart failure with normal ejection":HFREF group 105 cases,61 male and 44 female, aged 24-92 (68.91±12.03) years; HFNEF group 73 patients,24 males and 49 females, aged 25-91 (72.38±9.09) years. All the selected patients were asked the medical history, physical examination, laboratory tests and echocardiographic examinations. Excluded severe valvular heart disease (mitral and/or mouth aortic prosthetic regurgitation> 3+or/ and mitral valve area≤1CM2), pericardial disease, chronic respiratory diseases, autoimmune diseases, malignant tumor, severe liver and renal insufficiency, hereditary or acquired anemia, acute gastrointestinal bleeding. Following-up the death and readmission of time and number of each group after 24 weeks by telephone. To compared the similarities and differences of general information, etiology, laboratory tests and echocardiography between the two groups, compared the correlation of NT-ProBNP and MMP-9 and other related indexes. Following up the prognoisis of HFNEF and HFREF, to find out the prognostic indicators in HFNEF.Results:1.In all patients with chronic heart failure, the proportion of HFNEF is 41%. Elderly, women, patients with a history of hypertension have a higher proportion; 2.MMP-9 levels in HFNEF group is higher than HFREF group(7.24±4.02ng/ml vs 6.01±3.74ng/ml, P=0.037). NT-ProBNP, Hb, RBC, UA, CRP levels in HFNEF group is lower than HFREF group(P<0.01; 118.52±22.42 g/1 vs 127.03±22.60 g/1, P=0.014; 4.09±0.71×1012/1 vs 4.30±0.70×1012/1, P=0.043; 332.73±156.05 U/1 vs 411.23±158.33 U/1, P=0.003; 7.91±4.83 mg/dl vs 10.05±7.05 mg/dl, P=0.031); 3. Plasma NT-ProBNP level in HFNEF is positively correlated with levels of MMP-9, UA, CRP, LVDD, LVMI, NYHA classification (P=0.029; P= 0.013; P=0.004; P=0.032; P=0.008; P=0.001), and negatively correlated with IVST, LVPWT, LVEF (P=0.005; P=0.010; P=0.017); Plasma NT-ProBNP level in HFREF is positively correlated with levels of MMP-9, UA, CRP, LVDD, LVMI, NYHA classification, IVST, LVPWT(P=0.033; P=0.009; P=0.014; P=0.028;P= 0.032; P<0.01; P=0.037; P=0.026), and negatively correlated with LVEF (P= 0.017); 4. The occurrence of cardiovascular events in HFREF group is 27.6% and 24.6% in HFNEF group after 24 weeks, show no significant difference between the two groups (P=0.685). In HFREF group, the occurrence of cardiovascular events in cardiac function stageⅡis 0.96%, in stage III is 6.73%, in stageⅣis 20.2%, all the differences were statistic significance (P<0.01); In HFNEF, the rate of cardiovascular events in cardiac function stage III is 6.94%, in stage IV is 18.06%, all the differences were statistic significance (P<0.01);5.Female, MMP-9, CRP, NYHA classification, NT-ProBNP are independent predictors of cardiovascular events rate in HFNEF (P= 0.019; P<0.001; P=0.047; P=0.032; P= 0.043).Conclusion:1.The proportion of HFNEF is similar with HFREF in chronic heart failure; elderly,women, patients with a history of hypertension have a high proportion in HFNEF;2. MMP-9 levels in patients of HFNEF is higher than HFREF, NT-ProBNP, Hb, RBC, UA, CRP levels in HFNEF is lower than HFREF;3.Levels of NT-ProBNP in HFNEF is correlation with MMP-9, UA, CRP, LVDD, LVMI, NYHA classification, IVST, LVPWT, LVEF; Levels of NT-ProBNP in HFREF is correlation with MMP-9, UA, CRP, LVDD, LVMI, NYHA classification, IVST, LVPWT, LVEF;4. Prognosis of HFREF and HFNEF are quite similar;5. Female, MMP-9, CRP, NYHA classification, NT-ProBNP are independent predictors of cardiovascular events rate in HFNEF.