The Prognostic Study Of High-sensitivity Troponin I And N-terminal Pro B-type Natriuretic Peptide In Heart Failure With Preserved Left Ventricular Ejection Fraction With And Without Diabetes

Purpose:With the aging of the population,the incidence of diabetes,coronary heart disease and chronic heart failure will increase year by year.Heart failure with preserved ejection fraction is the main type of chronic heart failure,and HFpEF combined with DM will become a huge group.In terms of biomarkers for heart failure,N-terminal pro brain natriuretic peptide(NT-proBNP)is a traditional marker for the diagnosis and prognosis of heart failure,while the value of troponin I in predicting the prognosis of heart failure has only been gradually discovered in recent years.At present,there are few reports about hs-cTnI and NT-proBNP in HFpEF patients with DM.This study compared the baseline data、hs-cTnI and NT-proBNP levels of patients with HFpEF with and without DM to further understand the clinical characteristics of HFpEF patients with DM.Analyze the correlation between hs-cTnI and NT-proBNP and the prognosis of HFpEF patients with and without DM to explore the risk factors for poor prognosis and help evaluate the prognosis.Methods:This study is a retrospective study of 372 patients with HFpEF who were hospitalized in the cardiology department of our hospital from January 2018 to January 2020.There were 146 patients with DM and 226 patients without DM.The median value of hs-cTnI was 0.019 ng/mL and the median value of NT-ProBNP was 2360 pg/mL.Collect patients’ general conditions,disease history,laboratory examinations,cardiac color Doppler ultrasound,clinical medications,etc.The patients were followed up for heart failure re-admission,all-cause re-admission,cardiovascular death,all-cause death and other adverse events within one year after discharge.According to whether the patients had DM,they were divided into non-DM group and DM group,and defined hs-cTnI≥0.019ng/mL as high hs-cTnI,and NT-ProBNP≥2360pg/mL as high NT-ProBNP.Use SPSS23.0 to perform statistical analysis on all data,analyze the baseline data of HFpEF patients with or without DM,the baseline levels of hs-cTnI and NT-proBNP,and explore the prognostic value of hs-cTnI and NT-ProBNP in HFpEF patients with and without diabetes.Using MedCalc Statistical Software version 14.8.1 software,compare the ROC curves of hs-cTnI,NT-ProBNP,and hs-cTnI combined with NT-ProBNP with or without DM group,and evaluate its predictive value for prognosis.P<0.05 considered the difference to be statistically significant.Result:1.Among HFpEF patients,compared with patients without diabetes,patients with diabetes had a higher BMI and worse cardiac function,and more patients had a history of hypertension and chronic obstructive pulmonary disease.The difference was statistically significant(P<0.05).In addition,patients with diabetes have higher inflammatory indexes such as white blood cells and centrioles,higher blood lipid indexes,worse renal function,and longer average hospital stay.The difference between the groups was statistically significant(P<0.05).Compared with HFpEF patients without diabetes,HFpEF patients with diabetes had higher baseline levels of hs-cTnI and NT-proBNP,and the difference between the groups was statistically significant(P<0.05).2.1n HFpEF patients,whether with or without DM,patients with hs-cTnI≥0.019ng/ml had a higher incidence of heart failure readmission,all-cause readmission,cardiovascular death,all-cause death,and cumulative adverse events.Among them,HFpEF patients with DM have a worse prognosis than HFpEF patients without DM(P<0.05).Factors such as age,heart function,high-density lipoprotein,and glomerular filtration rate were included in the multivariate logistic regression correction and showed that,regardless of the presence or absence of DM,hs-cTnI≥0.019ng/ml is an independent risk factor for heart failure readmission,all-cause readmission,and cumulative adverse events.3.Among HFpEF patients with DM,patients with NT-proBNP≥2360 pg/mL had a higher rate of heart failure readmission,all-cause readmission,cardiovascular death,all-cause death,and cumulative adverse events(P<0.05).In patients without DM,NT-proBNP≥2360 pg/mL was only associated with heart failure readmission,all-cause readmission,and cumulative adverse events(P<0.05).Among them,HFpEF patients with DM have a worse prognosis than HFpEF patients without DM(P<0.05).Factors such as age,heart function,high-density lipoprotein,and glomerular filtration rate were incorporated into the multivariate logistic regression and adjusted to show that NT-proBNP≥2360 pg/mL is an independent risk factor for readmission to hospital for heart failure with or without diabetes.4.In HFpEF patients without DM,hs-cTnl combined with NT-proBNP has a higher predictive value for cumulative adverse events than NT-proBNP(P<0.05).In conclusion:1.With or without DM,hs-cTnI≥0.019ng/ml is an independent risk factor for the heart failure readmission,all-cause re-admission and cumulative adverse events of HFpEF patients.2.With or without DM,NT-proBNP≥2360 pg/mL is an independent risk factor for heart failure readmission of HFpEF patients.3.HFpEF patients with DM have higher baseline levels of hs-cTnI and NT-ProBNP,and patients with elevated hs-cTnI and NT-ProBNP have a worse prognosis.4.In HFpEF patients without DM,hs-cTnI combined with NT-proBNP has a higher predictive value for adverse events than NT-proBNP.