Effection Of Circulating Neuron Specific Enolase In Heart Failure Patients

Aims: To evaluate whether circulating serum neuron specific enolase (NSE) levelcould provide prognostic value in acute decompensated heart failure (ADHF) patients.Methods: The data of474ADHF patients were collected from the Shanghai6thPeople’s Hospital between January2009and December2011. Fasting Blood samples wereobtained the next day after enrollment. The patients were categorized into two groupsaccording to the NSE levels: high NSE group (≥14.915U/ml) and normal NSE group. Eachof the474patients completed every6months follow-up procedure either by visiting to theheart failure clinic, or by letter or phone interviews and through reviewing the hospital’smedical records. The mean follow-up period was24months. Multivariate logisticregression analysis was applied to determine the independent risk factors of death in theseheart failure patients.Results: After24months follow-up55(11.6%) patients died. The serum NSE level inthe death group was significantly higher than that of the survival group（[17.75±6.54U）/mlvs.(14.45±4.95)U/ml，P=0.01]. The degrees of NSE were closely correlated with theseverity of HF. The higher concentration of NSE, NYHA functional class was moreserious[NYHA functional classⅡ：(13.79±4.33)U/ml, NYHA functional classⅢ：(14.96±4.78)U/ml, NYHA functional class Ⅳ：(17.07±7.42)U/ml，P＜0.05)；Andpatients with higher NSE were more likely to have certain baseline characteristics, such asless LVEF, larger LVEDD and LVESD and higher NT-proBNP and CK-MB.Multivariatelogistic regression showed that NSE was an independent risk factor for the2year mortalityin patients with ADHF （HR1.060，95%CI：1.001-1.123，P=0.031）. The2-year survivalrate in patients with elevated serum NSE was significantly lower than that of the normal NSE group.Conclusions: The elevated serum NSE was an independent predictor for the2-yearmortality in ADHF patients. Objective: To determine whether circulation level of neuron specific enolase(NSE)could provide prognostic information independently of risk markers for the development ofin-hospital heart failure in patients with ST-segment elevation myocardialinfarction(STEMI).Methods: The data of508STEMI patients were collected from Shanghai6th People’sHospital between January2011and December2012.Clinical data were collected in themorning after admission, including serum NSE and N-terminal B type natriuretic peptide(NT-proBNP) concentration. Then we followed up patients’ heart failure situation afterhospitalization period, and divided them into heart failure group and non heart failuregroup. The two groups were compared the clinical characteristics and NSE, NT-proBNPconcentration. The relationship between NSE and each clinic factor was analysed bySpearman rank correlation， multivariate logistic regression analysis were applied todetermine the relationship between risk factors and in-hospital heart failure.Receiver-operator characteristic(ROC) curve was performed to evaluate the power of NSEand N terminal pro-brain natriuretic petide (NT-proBNP) on predicting in-hospital heartfailure.Results: STEMI patients were more susceptible to be heart failure,such as the women,the elderly, with a history of hypertension and diabetes, faster admission heart rate, lowerdiastolic pressure, and higher Cr, CRP, NSE, NT-proBNP concentration, greater leftventricular and lower left ventricular ejection fraction, anterior wall myocardial infarction.With the deterioration of heart function, the concentration of NSE, NT-proBNP increasedgradually（P＜0.001）.Spearman rank correlation analysis showed the the NSE waspositively correlated with CK,cTnI,CKMB（CK：r=0.550，P＜0.001；cTnI：r=0.531，P＜0.001； CKMB：r=0.477，P＜0.001）and negatively correlated with left ventricular ejection fraction(LVEF)（r=-0.342，P＜0.001）.After multivariate adjustment, NSEremainded to be an independent risk factor for the development of in-hospital heartfailure(HR=1.021，95%CI：1.003-1.040，P=0.023).The area under the ROC curves of NSEwas0.674（P＜0.001）.Conclusion: The NSE level is an independent predictor for the development ofin-hospital heart failure in patients with STEMI.