| Background Chronic congrestive heart failure is the end stage of various heart diseases, Its development basic mechanism is myocardial remodeling, accompanied by focal myocardial necrosis, apoptosis, progressive interstitial fibrosis, etc· Previous studies suggested that serum cTnl levels was mild increased in in patients with CHF, cTnl positivity was found to correlate with a worse clinical and functional status·Risk of death increased in Patients Elevated serum cTnl levels with chronic heart failure-But it is disputed whether serum cTnl level in decompensated heart failure is associated with in-hospital MACE, and biochemical markers of myocardial remodeling and the prognosis· The purpose of this study is to examine relationship between serum cTnl and cardiac structure function and its influence on recent adverse cardiac events in patients with decompensated heart failure, and to explore significance of serum cTnl in evaluation of CHF patients and prognosis·Objective to investigate the association between serum cardiac troponin I (cTnl) and cardiac function/structure in patients with chronic heart failure and its influence of the prognosis of CHF·MethodsOne hundred and three patients with decompensated chronic heart failure were included·The patients were divided into cTnl positive group (cTnl≥0·05ng/ml,n=51) and cTnl negative group (cTnl<0·05 ng/ml,n=52)·Left atrium diameter (LA), left ventricular end-diastolic diameter (LVEDD), right ventricular diameter(RV) as cardiac structural change index, left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) as cardiac function indexes were determined·Bivariate correlation analysis was applied to show the correlation of level of serum cTnl with above indices·The patients was observed in hospital for the occurrence of the primary composite end point(death, ventricular fibrillation, ventricular tachycardia, stroke, stubborn heart failure and cardiac resynchronization therapy (CRT) surgery)and followed for3months (range2to6months) for the primary composite end point(death and rehospitalization)·Kaplan-Meier analysis was performed on the three and six cumulative rates of survival stratified into different groups, and the change in cTnl levels and differences between survival curves were analyzed by log-rank test·Binary logistic regression was performed to show the correlation of serum cTnl level with composite end point event·Results①Serum cTnl levels among hypertensive heart disease, DCM and ICM,between patients with ischemic and no significant heart failure was no significant difference (P>0·05)·②cTnl levels in patients wirh III-IVwere significantly higher than in patients with NYHA class II (P<0.05)·③LA, LVEDD, BNP, NYHA cardiac function Ⅲ-Ⅳ ratio were significantly higher (P<0·05), LVEF were significantly lower (P<0·05) in cTnl positive group than in cTnl negative group· ④serum cTnl was positively correlation with LA, LVEDD, BNP (P<0·05), inversely correlated with LVEF (P<0·05), and RV no correlation (P>0·05)·⑤The cumulative incidence of primary composite end point of MACE increased30·10%(P<0·05), mainly due to increase of death and stubborn heart failure (P<0·05); The cumulative incidence of primary composite end point(death,rehospitalization) at three months increased30·77%(P<0·05),mainly due to increase of rehospitalization (P<0·05) in cTnl positive group than in cTnl negative group-The incidence of death end point at six months increased75·8%(P<0·05)·⑥Kaplan-Meier (Log-rank test) survival analysis showed that3months rehospitalization curve was higher in patients with cTnl positive than negative group, difference was statistically significant (Chi Square=8·751, P=8·757)·Follow-up3months survival curve is lower in the cTnl positive group than negative, but there was no statistically significant difference (Chi Square=3·267, P=0·077); Follow-up6months survival curve is lower in the cTnl positive group than negative, difference was statistically significant (Chi Square=5·077, P=0·025); The combination of cTnl and BNP improved predicting mortality in patients with CHF⑦Multivariate logistic regression analysis showed that cTnl concentration in patients with CHF is independent risk factors of MACE inhospital and the composite end point of death and rehospitalization at three months·Conclusion①Difference of Serum cTnl levels among different causes heart failure was no significant· ②Serum cTnl was significantly correlated with left heart dimensions and cardiac function, is predictive factors of cardiac remodeling and cardiac function in Patients with CHF·③linical outcome is worse in cTnl positive patients with CHF at hospitalization, three and six months·④survival analysis showed that Follow-up6months survival curve is significant lower in the cTnl positive group than negative,The ncombiation of cTnl and BNP improved predicting mortality in patients with CHF⑤Serum cTnl is one of independent risk factors of the clinical prognosis... |
PDF Full Text Request