| Objective:To investigate the clinical significance of growth differentiation factor 15(GDF-15) and soluble ST2(s ST2) combination with other factors in the diagnosis of cardiac function and disease evaluation in patients with chronic heart failure, we measure and observe the changes of GDF-15 s ST2 levels before and after treatment, and analyze the relationship between GDF-15,s ST2 and brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF) and other indicators.Methods:A total of 70 consecutive inpatients with chronic heart failure from November 2014 to Augst 2015 in the department of cardiology of Affiliated Hospital of Chengde Medical College were enrolled in the observation group(HF group),the patients were divided into class III(n=24) and class IV(n=46)according to the NYHA class;besides,the patients were divided into coronary heart disease group(n=35) and dilated cardiomyopathy group(n=35) according to the basis of heart disease.31 inpatients with hypertension or cardiac arrhythmias over the same period were recruited as control group.All the selected cases after admission to improve GDF-15,s ST2 detection in a routine examination,the observation group were reviewed before discharge. Clinical and laboratory data,echocardiogram indexes and BNP level were collected and analyzed.Results:1 Compared with control group,the level of GDF-15,s ST2,BNP in HF group were higher, the results were 1035(522,1440)pg/ml vs 58(34,78)pg/ml,850(787,998)pg/ml vs 213(98,366)pg/ml, 7222(5054,10123)pg/ml vs 2796(1945,5210)pg/ml,the differences were statistically significant(P<0.05).The levels of GDF-15,s ST2 and BNP in NYHA III and NYHA IV class were higher than control group, and the levels increases with the increase of NYHA class, Compared with NYHA III class,the level of GDF-15,s ST2,BNP in NYHA IV class were higher, the results were 491(204,871)pg/ml vs 1195(959,1825)pg/ml, 835(733,898)pg/ml vs 897(798,1083)pg/ml,5767(3570,8733)pg/ml vs 2796(1945,5210)pg/ml, the differences were statistically significant(P<0.05).2 Compared with control group,the levels of GDF-15,s ST2 and BNP in HF group before and after treatment were higher,and the levels after treatment were lower than before, the results were 1035(522,1440)pg/ml vs 490(193,859) pg/ml vs 58(34,78)pg/ml; 850(787,998)pg/ml vs 704(480,774)pg/ml vs 213(98,366)pg/ml;7222(5054,10123)pg/ml vs 4692(3443,7280)pg/ml vs 2796(1945,5210)pg/ml,the differences were statistically significant(P<0.05).3 Compared with control group of echocardiographic parameters,the levels of LAD,LVEDD and LVMI in HF group were higher,and the levels of LVEF,RWT were lower,the results were 46.2±7.4mm vs 31.8±4.7mm,66.1±10.7mm vs 47.7±4.4mm,178.4±54.8g/m2 vs 94.5±19.8g/m2,36.7±11.8% vs 60.5±6.0%,0.28±0.06 vs 0.37±0.05,the differences were statistically significant(P<0.05).In HF group,the levels of LAD,LVEDD and LVMI increase with the increase of NYHA class, and the levels of LVEF,RWT were decrease with the increase of NYHA class,the results were 45.8±7.3mm vs 46.5±7.5mm,62.0±11.1mm vs 68.2±10.0mm,167.6±61.9g/m2 vs 184.0±50.6g/m2,43.0±11.6% vs 33.4±10.6%,0.30±0.05 vs 0.26±0.06 respectively,the differences were statistically significant(P<0.05). 4 The patients with chronic heart failure were divided into coronary heart disease group and dilated cardiomyopathy group according to the basis of heart disease.Compared with coronary heart disease group,the levels of age,BMI,blood pressure,LVEF and RWT were lower in the dilated cardiomyopathy group,the results were 57.9±12.9 years vs 72.7±7.4years, 22.6±2.5kg/m2 vs 24.3±3.8kg/m2,118.2±19.8mm Hg vs 134.2±18.2mm Hg,75.5±11.1mm Hg vs 82.9±12.9mm Hg,30.5±9.4% vs 42.9±10.7%,0.25±0.04 vs 0.30±0.06;the levels of LAD,LVEDD,LVMI and BNP were higher in the dilated cardiomyopathy group,the results were 48.9±7.8mm vs 43.5±5.8mm,71.2±8.2mm vs 61.0±10.6mm,201.1±52.5g/m2 vs 155.6±47.8g/m2, 1090(903,1798)pg/ml vs 838(292,1250)pg/ml,the differences were statistically significant(P<0.05).But the levels of GDF-15 and s ST2 in the two groups compared,the differences were not statistically significant(P>0.05),the results were 842(774,1080)pg/ml vs 869(787,941)pg/ml,6913(4903,9577)pg/ml vs 7634(5193,10976)pg/ml respectively.5 Spearman correlation analysis showed that BNP,s ST2,GDF-15 were positive correlation with NYHA class and LVMI(r=0.579,0.339,0.305;0.449, 0.351,0.236;P all<0.05),while negative correlation with LVEF and RWT(r=-0.496,-0.380,-0.255;-0.409,-0.257,-0.298;P all<0.05).s ST2 and GDF-15 were positive correlation with BNP(r=0.289,0.300;P all<0.05).6 ROC curve analysis showed that the area of NYHA III and NYHA IV with BNP,GDF-15 and s ST2 were 0.852,0.678 and 0.706(P<0.05) respectively,the optimal cut-off points were 884pg/ml, 855pg/ml and 5947pg/ml, the sensitivity were 76.1%,58.7% and 80.4% respectively,and the specificity were 79.2%, 70.8% and 62.5% respectively. ROC curve analysis showed that the area of NYHA III and NYHA IV with BNP+GDF-15, BNP+s ST2 and BNP+GDF-15+s ST2 were 0.880,0.848 and 0.874(P<0.05) respectively,the sensitivity were 78.3%,82.6% and 78.3% respectively, and the specificity were 83.3%,79.2% and 83.3% respectively.Conclusions:1 Serum levels of GDF-15 and s ST2 can reflect the severity of heart failure,and they are effective indicators to evaluate the cardiac function,which can be new biomarkers of heart failure.2 Serum GDF-15 and s ST2 levels were not affected by age,gender,body mass index and other factors,which may be independent of BNP for heart failure diagnosis and prognosis evaluation.3 Serum GDF-15 and s ST2 can be used as important supplementary means of BNP and echocardiography,and there a certain significance for the diagnosis and antidiastole of heart failure,and multi index combined detection can effectively improve the diagnostic efficiency of heart failure. |
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