Yang Xiyan, Xing Yu, Li Kuibao
Heart Center, Beijing Chaoyang Hospital, Capital Medical University & Beijing Key Laboratory of Hypertension, Beiing, China.
Ann Palliat Med. 2021 Jul;10(7):7970-7976. doi: 10.21037/apm-21-1361.
The incidence of hypertension is continuously increasing. This study aimed to investigate the changes in clinical biochemical indexes of patients with heart failure with preserved ejection fraction (HFpEF), or patients with hypertensive heart disease (HHD) before and after treadmill exercise.
Seventy-eight patients with HFpEF and 78 patients with HHD who were admitted to our hospital between February 2020 and February 2021 were selected to take a treadmill exercise test. All patients continued to exercise for 1 month. Clinical biochemical indexes [hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), total cholesterol (TC), N-segment pro-brain natriuretic peptide (NT-proBNP), and cardiac troponin I (cTnI)] were measured before and after the treadmill exercise test and compared between the two groups. Receiver operating characteristic (ROC) curves were drawn to analyze the optimal cutoff values of the clinical biochemical indexes in the diagnosis of HFpEF. The positive diagnostic rates of the biochemical indicators for HFpEF before and after treadmill exercise were compared using the optimal cut-off value of ROC as the positive standard.
Before exercise, there was no significant difference in HbA1c, LDL-C, HDL-C, or TC between the two groups (P>0.05), but NT-proBNP and cTnI were significantly higher in the HFpEF group than in the HHD group (P<0.05). ROC curve analysis showed that before exercise, the best cutoff values for plasma NT-proBNP and cTnI in the diagnosis of HFpEF were 2,248.24 pg/mL and 1.14 ng/mL, respectively. After exercise, no significant difference was found in HbA1c, LDL-C, HDL-C, or TC between the two groups (P>0.05). However, the levels of NT-proBNP and cTnI in both groups were higher after exercise, with more significant increases seen in the HFPEF group (P<0.05). The positive rates of plasma NT-proBNP and cTnI in HFpEF group were statistically higher after exercise than before exercise (P<0.05).
The changes in plasma NT-proBNP and cTnI in patient after treadmill exercise can be used as sensitive indicators for the diagnosis and differentiation of HFpEF and HHD.
高血压的发病率持续上升。本研究旨在调查射血分数保留的心力衰竭（HFpEF）患者或高血压性心脏病（HHD）患者在平板运动前后临床生化指标的变化。
选取2020年2月至2021年2月期间我院收治的78例HFpEF患者和78例HHD患者进行平板运动试验。所有患者持续运动1个月。在平板运动试验前后测量临床生化指标[糖化血红蛋白（HbA1c）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、总胆固醇（TC）、N末端脑钠肽前体（NT-proBNP）和心肌肌钙蛋白I（cTnI）]，并在两组之间进行比较。绘制受试者工作特征（ROC）曲线，分析临床生化指标在HFpEF诊断中的最佳截断值。以ROC的最佳截断值为阳性标准，比较平板运动前后HFpEF生化指标的阳性诊断率。
运动前，两组患者的HbA1c、LDL-C、HDL-C或TC无显著差异（P>0.05），但HFpEF组的NT-proBNP和cTnI显著高于HHD组（P<0.05）。ROC曲线分析显示，运动前，血浆NT-proBNP和cTnI诊断HFpEF的最佳截断值分别为2248.24 pg/mL和1.14 ng/mL。运动后，两组患者的HbA1c、LDL-C、HDL-C或TC无显著差异（P>0.05）。然而，两组运动后的NT-proBNP和cTnI水平均升高，HFPEF组升高更显著（P<0.05）。HFpEF组运动后血浆NT-proBNP和cTnI的阳性率在统计学上高于运动前（P<0.05）。
平板运动后患者血浆NT-proBNP和cTnI的变化可作为HFpEF和HHD诊断及鉴别的敏感指标。
