Changes And Roles Of Plasma Hydrogen Sulfide In Elderly Patients With Ischemic Heart Failure

Objective: Coronary heart disease is the common cardiovascular disease, also known as ischemic heart disease (IHF). Myocardial ischemia, necrosis for a long time cause ischemic heart failure eventually. The elderly is a high incidence group of ischemic heart disease. With the increasing incidence of coronary heart disease, the incidence of elderly patients with IHF is increasing year by year. Hydrogen sulfide (H2S), as the third endogenous gaseous signaling molecule which was discovered by human has an important pathophysiology significance in the development of the nervous system, digestive system, respiratory system, urinary system and cardiovascular system diseases. Especially its far-reaching significance of the cardiovascular system is worthy of our attention. It has been gradually recognized by studying it. In the cardiovascular system it has the roles such as relaxing blood vessels, protecting the vascular endothelium, blood pressure, anti-oxidation, myocardial protection and so on, but there is not enough research on its roles in elderly patients with IHF. While sodium nitroprusside as an effective treatment for drug in heart failure patients, its role of intervention in elderly patients with IHF as well as the relationship between plasma H2S have not been studied. In addition NT-ProBNP has become a new clinical indicator of differential diagnosis and evaluation of degree of heart failure, with few studies on the relationship between H2S. In this study, we discuss the change of H2S levels in the elderly IHF patients blood and effect of the SNP intervention, to provide a theoretical basis for the severity, treatment and prognosis on the elderly IHF patients.Methods: Select 47 aged patients with IHF, in which 17 cases with old myocardial infarction, 17 cases with unstable angina, 13 cases with stable angina pectoris, then in accordance with New York Heart Association (NYHA) heart function class screen for heart functionⅣgrade 14 cases,Ⅲgrade 18 cases,Ⅱgrade 15 cases, 15 cases without hypertension, coronary heart disease, diabetes as control group. Cardiac functionⅢ,Ⅳgrade patients in heart failure are randomly divided into the general treatment group and the general treatment + SNP group. Both of the groups have actively anti-infection, correction of electrolyte disorders therapy, at the same time to give cardiac drugs, diuretics, angiotensin converting enzyme inhibitor and oral nitrates therapy. Patients in general treatment group who have no significant remission in symptoms within 24 hours are included general treatment + SNP group, and ultimately the general treatment group has 12 cases, the general treatment + SNP group has 20 cases. Before treatment and after the treatment of post-effective (as long as the heart function of all patients restore a level more than on admission that is considered valid) determine plasma levels of H2S and NT-ProBNP by quantitative ELISA, while record blood pressure, heart rate, respiratory rate and breathing difficulties , pulmonary rales, lower extremity edema and so on.Results: The levels of H2S in elderly patients with ischemic heart failure (30.78±9.69μmol/L) were significantly lower than that of normal controls (50.25±4.26μmol/L), and then they decrease with deterioration of NYHA function class. [NYHAⅡcase (41.37±4.17μmol/L), NYHAⅢcase (30.76±4.88μmol/L), NYHAⅣcase (19.44±3.82μmol/L), P﹤0.05], the levels of H2S showed a negative correlation to the cardiac function (r=-0.90, P﹤0.01) and the levels of NT-ProBNP (r=-0.81, P﹤0.01). The levels of plasma H2S (23.19±7.81μmol/L) were significantly increased after treatment with sodium nitroprusside (51.87±3.42μmol/L) in the IHF group, as compared to the group not receiving treatment with sodium nitroprusside (43.52±7.92μmol/L, P﹤0.05).Conclusion: H2S levels in plasma of the elderly patients with IHF are significantly lower, and relate to cardiac function class NYHA and NT-ProBNP, which suggest that endogenous H2S may be involved in the development and progression of the elderly IHF; while SNP can improve cardiac function of elderly patients with IHF, and the levels of endogenous H2S are increased in the intervention of SNP, so the modulation of endogenous H2S production may be one of roles of Sodium nitroprusside in improving heart function.