| Objective:The aim of this study was to measure plasma amino-terminal pro-brain peptide precursor (NT-proBNP) and serum thyroid hormone levels in chronic heart failure (CHF) patients, and evalute their role in the development of CHF and prognostic value.Methods:There were 150 patients with CHF who had been treated from June 2008 to December 2014 in our hospital were enrolled in this study, including 95 male (63.3%) and 55 female (36.7%) at the mean age of (62.3 ± 11.5) years. According to the NYHA classification,patients were divided into NYHA class II group(n=35), NYHA class III group(n=65), NYHA class IV group(n=50)..Additionally, the health examination population in the health department of our hospital were selected as the control group, including 100 male (66.7%) and 50 female (33.3%) at the mean age of (62.1 ±11.4) years. Left ventricular ejection fraction (LVEF) in control group were more than 50%.We collected the general information of the study population and extracted their fasting elbow venous blood to examine the blood biochemical biomarkers、the plasma NT-proBNP concentration the free three iodine thyroid original ammonia acid (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) levels. Furthermore, we used the echocardiography to examine the left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDd), interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW) and left ventricular ejection fraction (LVEF) in all study population.CHF patients were followed up every three months after treatment by telephone to record whether they suffered cardiovascular events or not。Results:(1) the diagnostic value of plasma NT-proBNP and serum thyroid hormone levels in CHF patients1. The triglyceride, total cholesterol, high sensitivity C-reactive protein (hs-CRP) and NT-proBNP levels in CHF group were significantly higher than those of the control group {P<0.05), however, the FT3 level was significantly lower than that of the control group (P < 0.05); Cardiac ultrasound showed that LAD, LVEDd in CHF patients were significantly higher than that of control group (P<0.05), and IVS, LVPW and LVEF were significantly lower than that of the control group (P<0.05).2. The NT-proBNP level increased gradually with cardiac functional grading increased, however, the FT3 level increased with cardiac functional grading decreased, the trend test had statistical significance (P<0.001); As the same, LAD and LVEDd increased with cardiac functional grading increased, IVS, LVPW and LVEF increased with cardiac functional grading decreased.3. There were negative correlation between FT3 level and NT-proBNP (r=-0.78, P< 0.01), LAD (r=-0.42, P< 0.01), LVEDd (r=-0.39, P<0.01). However, there were positive correlation between FT3 level and LVEF (r=0.62, P<0.01), IVS (r=0.42, P< 0.05), LVPW (r=0.57, P< 0.05).4. Multivariate logistic regression analysis showed that NT-proBNP level (OR=3.32, 95%CI=2.41-5.39, P< 0.001), FT3 level (OR= 0.89,95%CI=0.77-0.93, P< 0.001) and LVEDd (OR=1.14,95%CI=1.06-1.38, P= 0.034) were the independent risk factors in the diagnosis of CHF.5. The sensitivity of plasma NT-proBNP in CHF diagnosis was 89.4%, specificity was 93.0%, the positive predictive value was 97.0%, negative predictive value was 77.8%. The sensitivity of serum FT3 in CHF diagnosis was 86.5%, specificity was 89.6%, the positive predictive value was 95.4% and the negative predictive value was 72.5%.(2) The prognostic value of plasma NT-proBNP and serum thyroid hormone levels in CHF patients.1. The levels of triglyceride, total cholesterol and NT-proBNP in CHF patients with cardiovascular events were significantly higher than those without cardiovascular events(P<0.05),and the level of FT3 was significantly lower (P<0.05).2. The sensitivity of plasma NT-proBNP to evalute cardiovascular events was 62.5%, the specificity was 58.8%, the positive predictive value was 41.7% and the negative predictive value was 76.9%; the sensitivity of serum FT3 was 79.2%, the specificity was 76.5%, the positive predictive value was 61.3% and the negative predictive value was 88.6%.3. The median non cardiovascular event occurrence time of NT-proBNP high expression group (>5324.6pg/ml) was 28.5 months, and the median non cardiovascular event occurrence time of NT-proBNP low expression group (<5324.6pg/ml) was 47.5 months, there was significant difference between the two groups (P=0.005); The median non cardiovascular event occurrence time of low FT3 expression group (<2.58pmol/L) was 30.2 months, and the median non cardiovascular event occurrence time of high FT3 expression group (>2.58pmol/L) was 50.6 months, there was significant difference between the two groups (P< 0.001).4. Cox proportional hazard regression model analysis showed that NT-proBNP (HR=3.29,95%CI=1.67-5.92, P=0.001) and FT3 (HR= 0.45,95%CI=0.27-0.79, P= 0.023) levels were the independent risk factors of CHF prognosis.Conclusion:1.NT-proBNP level increases gradually and FT3 level decreased with the deterioration of heart function,indicating that NT-proBNP and FT3 could reveal the severity of heart failure and may be sensitive indicators to evaluate cardiac function.2.FT3 level was negatively correlated with LAD and LVEDd and positively correlated with LVEF、IVS and LVPW, NT-proBNP level was positively correlated with LAD and LVEDd and negatively correlated with LVEF、IVS and LVPW。FT3 and NT-proBNP are associated with the progress of left ventricular remodeling.3.NT-proBNP in cardiovascular event group were significant higher and FT3 were significant lower than those in non-cardiovascular event group, NT-proBNP and FT3 are the independent indicators in the diagnosis of CHF and the evaluation of cardiovascular events. |
PDF Full Text Request