| Objective:To investigate the diagnostic value of plasma Vaspin in patients with heart failure with preserved ejection fraction(HFpEF)and its correlation with inflammatory and volume indexes.Methods:A total of 169 inpatients in the Cardiology Department of our hospital from December 2020 to December 2021 were selected and divided into non-HF group of 50 cases and total HF group of 119 cases according to whether they had heart failure(HF).According to left ventricular ejection fraction(LVEF),HF group was divided into HFpEF group of 50 cases,HFmrEF group of 36 cases and HFrEF group of 33 cases.Gender,age,body mass index(BMI),whether combined with hypertension,coronary heart disease(CHD),atrial fibrillation(AF),type 2 diabetes and other medical history data,white blood cells(WBC),red blood cell volume distribution width(RDW),medium The number of neutrophils,lymphocytes,high sensitivity C-reactive protein(hs-CRP),hemoglobin(Hb),hematocrit(HCT),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-ch),low density lipoprotein cholesterol(LDH-ch),blood potassium(K+),blood sodium(Na+),blood homocysteine(Hcy),N-terminal B-type natriuretic peptide precursor(NT-proBNP)and other biochemical indicators,as well as cardiac ultrasound indicators such as left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd),and LVEF.Neutrophil to lymphocyte ratio(NLR)was calculated,and plasma volume(ePVS)was estimated based on Hb and HCT using Duarte formula.Plasma Vaspin levels were determined by enzyme-linked immunosorbent assay(ELISA).SPSS21.0 statistical software was used for statistical analysis,and pearson or spearman correlation analysis to analyze the correlation between Vaspin and inflammatory indicators(WBC,RDW,NLR,hs-CRP),and volume indicators(ePVS);multivariate binary logistic regression was used to analyze the independent influencing factors of HFpEF,HFmrEF and HFrEF;receiver operating characteristic curve(ROC)was drawn to evaluate the diagnostic value of Vaspin for different types of HF.Results:1.There were no significant differences in gender,age,hypertension,CHD,AF and type 2 diabetes among the four groups(P>0.05).BMI was statistically significant(P<0.05).2.Compared with non-HF group,ePVS,WBC,RDW,NLR,HS-CRP,NT-probNP,Vaspin and LAD in HFpEF group were significantly different(P<0.05);there were significant differences in WBC,RDW,NLR,Hs-CRP,NT-probNP,Vaspin,LAD,LVEDd and LVEF in HFmrEF group(P<0.05),ePVS was not statistically significant(P>0.05);there were statistically significant differences in RDW,NLR,Hs-CRP,HDL-CH,NT-probNP,Vaspin,LAD,LVEDd and LVEF in HFrEF group(P<0.05),ePVS was not statistically significant(P>0.05);compared with HFrEF,LAD,LVEDd and LVEF were significantly different in HFpEF group(P<0.05),ePVS,WBC,RDW,NLR,hs-CRP,NT-proBNP,Vaspin had no statistical significance(P>0.05);compared with HFmrEF group,LVEDd and LVEF in HFpEF group were significantly different(P<0.05),ePVS,WBC,RDW,NLR,hs-CRP,NT-proBNP,vaspin had no statistical significance(P>0.05);Compared with HFmrEF group,RDW,LAD and LVEF in HFrEF group were significantly different(P<0.05),there was no statistical significance in ePVS,WBC,NLR,hs-CRP,NT-proBNP and Vaspin(P>0.05).3.Compared with the non-HF group,the plasma Vaspin level in the total HF group was lower than that in the non-HF group,and the difference was statistically significant(P<0.001).4.Correlation analysis results show that:Vaspin was negatively correlated with inflammatory indexes(WBC,RDW,NLR,hS-CRP),NT-probNP with statistically significant differences(P<0.05),but not with the volume index ePVS,with statistically significant differences(P>0.05).5.Multivariate binary logistic regression analysis,after adjusting for related factors,RDW,NLR,and Vaspin were the independent influencing factors for the occurrence of HFpEF(OR=5.057,95%CI:1.368-18.690,P=0.015;OR=1.581,95%CI:1.005～2.487,P=0.047;OR=0.176,95%CI:0.061～0.506,P=0.001);RDW,NLR,hs-CRP,and Vaspin were independent influencing factors of HFmrEF(OR=4.290,95%CI:1.380-13.341,P=0.012;OR=1.517,95%CI:1.035-2.224,P=0.033;OR=1.573,95%CI:1.036～2.388,P=0.033;OR=0.242,95%CI:0.089～0.660,P=0.006);RDW、Vaspin 为 HFrEF 发生的独立影响因素(OR=3.685,95%CI:1.235～11.001,P=0.019;OR=0.205,95%CI:0.064～0.653,P=0.007).6.Vaspin and inflammatory indicators(RDW,NLR,hs-CRP)draw ROC curves for HFpEF,HFmrEF,and HFrEF,respectively,Vaspin+RDW+NLR draws ROC curves for HFpEF,and Vaspin+RDW+NLR+hs-CRP draws ROC curves for HFmrEF.Vaspin+RDW plots the ROC curve for HFrEF and calculates the AUC.The results showed:The AUC of HFpEF diagnosed by Vaspin was 0.892(95%CI:0.831-0.953),the cut-off value was 9.68ng/mL,the sensitivity was 98%,and the specificity was 68.6%;RDW diagnosed HFpEF with AUC of 0.844(95%CI:0.767～0.921),cut-off value of 12.95%,sensitivity of 71.4%,specificity of 86.3%.;the AUC for NLR diagnosis of HFpEF was 0.835(95%CI:0.753-0.917),the cut-off value was 2.12,the sensitivity was 89.8%,and the specificity was 72.5%;the AUC of Vaspin+RDW+NLR combined diagnosis of HFpEF was 0.956(95%CI:0.921-0.990),the sensitivity was 95.5%,and the specificity was 82.4%.The AUC of HFmrEF diagnosed by Vaspin was 0.872(95%CI:0.781～0.964),the cut-off value was 8.52ng/mL,the sensitivity was 70.0%,and the specificity was 91.8%.;RDW diagnosed HFmrEF with AUC of 0.722(95%CI:0.588～0.857),cut-off value of 12.55%,sensitivity of 75.0%,specificity of 67.3%;the AUC of NLR diagnosis HFmrEF was 0.829(95%CI:0.708～0.949),the cut-off value was 3.02,the sensitivity was 70.0%,and the specificity was 89.8%;the AUC of HFmrEF diagnosed by HS-CRP was 0.761(95%CI:0.582～0.941),the cut-off value was 4.69mg/L,the sensitivity was 70.0%,the specificity was 100%;the AUC of Vaspin+RDW+NLR+Hs-CRP for HFmrEF was 0.970(95%CI:0.932-1.000),the sensitivity was 95.5%,and the specificity was 82.4%.The AUC of Vaspin in diagnosing HFrEF was 0.857(95%CI:0.778～0.936),the cut-off value was 10.03ng/mL,the sensitivity was 93.0%,the specificity was 64.0%;The AUC of RDW for HFrEF diagnosis was 0.900(95%CI:0.829-0.971),the cut-off value was 12.95%,the sensitivity was 81.8%,and the specificity was 86%;The AUC of Vaspin+RDW combined diagnosis of HFrEF was 0.958(95%CI:0.921-0.996),the sensitivity was 90.9%,and the specificity was 90.0%.Conclusion:1.The plasma Vaspin level was significantly decreased in HF patients.There was no difference in plasma Vaspin level between HFpEF,HFmrEF and HFrEF patients.2.Vaspin was negatively correlated with inflammatory indexes(WBC,RDW,NLR,HS-CRP),but not with ePVS.3.RDW,NLR and Vaspin were the independent influencing factors of HFpEF.RDW,NLR,CRP and Vaspin were the independent influencing factors of HFmrEF.RDW and Vaspin were the independent influencing factors of HFrEF.4.Vaspin can be used as a serological index to evaluate the diagnosis of HFpEF,HFmrEF and HFrEF,and has a better diagnostic value for HFpEF.Vaspin,RDW,NLR,Vaspin+RDW+NLR all had better diagnostic value for HFpEF,the value of Vaspin in the diagnosis of HFpEF was higher than that of RDW and NLR when each index was detected alone,and the combination of Vaspin and RDW had the highest diagnostic value for HFpEF;Vaspin,RDW,NLR,HS-CRP and Vaspin+RDW+NLR+HS-CRP can be used to diagnose HFmrEF,the value of Vaspin in the diagnosis of HFmrEF was higher than that of RDW and NLR when each index was detected alone,and the combination of the four indexes has the highest diagnostic value for HFmrEF;for HFrEF,Vaspin,RDW and Vaspin+RDW can diagnose HFrEF better,the value of RDW in diagnosing HFrEF was higher than that of Vaspin when each index was detected alone.and the combination of the two indexes has the highest diagnostic value for HFrEF.The combined index had the highest diagnostic value for HF,Vaspin+RDW+NLR had the highest diagnostic value for HFpEF,Vaspin+RDW+NLR+hs-CRP had the highest diagnostic value for HFmrEF,and Vaspin+RDW had the highest diagnostic value for HFrEF. |
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