Bazaeva E V, Myasnikov R P, Metelskaya V A, Boytsov S A
Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia.
Kardiologiia. 2017 Mar;57(3):39-45.
The study of the diagnostic value of biochemical markers of myocardial stress and inflammation in chronic heart failure (CHF) with different values of the ejection fraction (EF) of the left ventricle (LV).
The cross-sectional study included 105 patients aged 24 to 84 years (mean 58+/-14 years) with stable chronic heart failure I-II NYHA functional class classification. The causes of CHF were ischemic heart disease (IHD) in 33% of patients and arterial hypertension (AH) - 67%. All patients received medical treatment: angiotensin-converting enzyme (ACE) - 76%, -blockers - 72%, diuretics - 100%, statins - 80%. The control group consisted of 35 healthy volunteers. All subjects identified blood natriuretic peptide (NT-proBNP, ANP), adiponectin, galectin-3, pentraxins-3 and growth differentiation factor-15 (GDF-15) by enzyme immunoassay (ELISA). All surveyed performed transthoracic echocardiography (Echo).
The blood NT-proBNP, ANP, galectin-3, pentraxins and GDF-3-15 in patients with chronic heart failure was significantly higher than in the control group (p<0.001 in all cases). In contrast, the level of adiponectin was significantly higher than in healthy individuals - 11.90 (11.39; 12.65) vs 7.73 (3.58; 8.86) ng/ml in patients with chronic heart failure (p<0.001). LVEF ranged from 30 to 55%, in 33% of patients it was >50%. Correlation analysis Spearman found strong correlations (p<0.001 for all markers) between LVEF and the content of all the biomarkers, while between the PV and the level of adiponectin is a positive correlation was found (r=0.862), and between the PV and the other biomarkers - reverse (r from -0.858 to -0.901). Multivariate linear regression analysis found the strongest correlation with the value of LVEF at pentraxin 3 and adiponectin. Subsequent ROC-analysis confirmed the diagnostic value of adiponectin in patients with heart failure and preserved ejection fraction. Thus, the level of adiponectin more than 8.3 ng/ml served as a prognostic factor for the presence of heart failure in patients with LVEF >50% with a sensitivity of 94.3% and a specificity of 92.9% (area under the curve 0.977; 95% confidence interval from 0.954 to 0.999; p<0.001).
Among the 6 studied biomarkers of myocardial stress and inflammation only adiponectin has diagnostic significance in patients with heart failure and preserved ejection fraction.
研究左心室射血分数（EF）值不同的慢性心力衰竭（CHF）患者中心肌应激和炎症生化标志物的诊断价值。
横断面研究纳入了105例年龄在24至84岁（平均58±14岁）、纽约心脏协会（NYHA）心功能分级为I-II级的稳定慢性心力衰竭患者。CHF的病因在33%的患者中为缺血性心脏病（IHD），67%为动脉高血压（AH）。所有患者均接受药物治疗：血管紧张素转换酶（ACE）抑制剂-76%，β受体阻滞剂-72%，利尿剂-100%，他汀类药物-80%。对照组由35名健康志愿者组成。所有受试者通过酶联免疫吸附测定（ELISA）法检测血中利钠肽（NT-proBNP、ANP）、脂联素、半乳糖凝集素-3、五聚素-3和生长分化因子-15（GDF-15）。所有受检者均进行经胸超声心动图（Echo）检查。
慢性心力衰竭患者血中的NT-proBNP、ANP、半乳糖凝集素-3、五聚素和GDF-3-15显著高于对照组（所有病例p<0.001）。相比之下，脂联素水平显著高于健康个体——慢性心力衰竭患者为11.90（11.39；12.65）ng/ml，而健康个体为7.73（3.58；8.86）ng/ml（p<0.001）。左心室射血分数（LVEF）范围为30%至55%，33%的患者LVEF>50%。Spearman相关分析发现LVEF与所有生物标志物含量之间存在强相关性（所有标志物p<0.001），而左心室射血分数与脂联素水平之间呈正相关（r=0.862），与其他生物标志物之间呈负相关（r从-0.858至-0.901）。多变量线性回归分析发现五聚素3和脂联素与LVEF值的相关性最强。随后的ROC分析证实了脂联素在射血分数保留的心力衰竭患者中的诊断价值。因此，脂联素水平>8.3 ng/ml是LVEF>50%患者心力衰竭存在的预后因素，敏感性为94.3%，特异性为92.9%（曲线下面积0.977；95%置信区间为0.954至0.999；p<0.001）。
在研究的6种心肌应激和炎症生物标志物中，只有脂联素在射血分数保留的心力衰竭患者中具有诊断意义。
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