| Objective:To analyze the correlation and diagnostic value of serum homocysteine(Hcy),methionine(Met)and cysteine(Cys)in patients with chronic heart failure(CHF)Methods:One hundred and seventy-eight patients with acute decompensation chronic heart failure who were admitted in Affiliated Zhongshan hospital of Dalian university were continuously enrolled from Oct.2018 to Sep.2019 as CHFgroup,and Seventy healthy persons were selected as heathy control group,they were all came from Affiliated Zhongshan hospital of Dalian university at the same time.While,CHF group was divided into three sub-group according to the left ventricular ejection fraction and NT-proBNP,there were heart failure with reduced ejection fraction group(HFrEF),n=53,heart failure with mid-range ejection fraction group(HFmrEF),n=50,and heart failure with preserved ejection fraction group(HFpEF),n=75.Detection of serum Hcy,Met and Cys by tandem mass spectrometry.Determination of NT-proBNP by electrochemiluminescence immunoassay.Left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd)and E/e’ were detected by echocardiography,then calculated left ventricular eject fraction(LVEF).Firstly,serum Hcy,met,Cys,NT-proBNP,LVEDd,LVEF,E/e’ were compared between heart failure group and normal control group Secondly,Pearson correlation analysis was used to analyze the correlation of indicators The receiver operator haracteristic(ROC)curve was drawn,and the area under curve(AUC)was used to evaluated the efficacy of serum Hcy,Met,Cys,NT-proBNP,and LVEF in the diagnosis of CHF.Results:Serum Hcy,Met,Cys,NT-proBNP,LVEDd and E/e’ in CHF group was significantly higher than those in healthy control group,and LVEF significantly lower than healthy control group,there were statistical differences(p<0.01 or<0.05).Pearson correlation analysis result showed that serum Hcy,Met and Cys were positively correlated with NT-proBNP and E/e’(r=0.632,r=0.206,r=0.455 and r=0.463,r=0.198,r=0.346 p<0.01),negatively correlated with LVEF(r=-0.491,r=-0.252,r=-0.330 p<0.01 or<0.05)Serum Hcy was positively correlated with LVEDd(r=0.327,P<0.01),while met and Cys were not correlated with LVEDd(r=-0.010、r=0.125 P≥0.05).The results of comparison among HFpEF,HFmrEF and HFrEF groups are as follows,the serum Hcy,Cys of HFmrEF and HFrEF patients significantly higher than thoes of HFpEF patients,the difference was statistically significant(p<0.01 or<0.05);there was no statistical difference between HFmrEF and HFrEF patients(p>0.05);The serum Met of HFrEF patients was significantly higher than that of HFpEF and HFmrEF patients,and there were statistical differences(p<0.05);there was no statistical difference between HFPEF and HFmrEF patients(p>0.05).ROC curve analysis result showed that the cut-off value for the diagnosis of CHF in serum NT-proBNP based on the maximum Youden index(0.994)was 120pg/L,AUC was 0.994,and 95%CI was 0.997～1.000;the cut-off value for the diagnosis of CHF in serum Hcy based on the maximum Youden index(0.646)was 10.56μmol/L,AUC was 0.899(95%CI 0.859 to 0.939),the cut-off value for the diagnosis of CHF in serum Met based on the maximum Youden index(0.218)was 25.58μmol/L,AUC was 0.637(95%CI 0.563 to 0.711),the cut-off value for the diagnosis of CHF in serum Cys based on the maximum Youden index(0.391)was 298.05μmol/L,AUC was 0.765(95%CI 0.700 to 0.830)Conclusion:The levels of serum Hcy is closely related to chronic heart failure and the severity of it.Moreover,serum Hcy has certain application value in the diagnosis of heart failure with preserved ejection fraction. |
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