Balletti Alessio, De Biase Nicolò, Del Punta Lavinia, Filidei Francesco, Armenia Silvia, Masi Filippo, Di Fiore Valerio, Mazzola Matteo, Bacca Alessandra, Dini Frank L, Taddei Stefano, Masi Stefano, Pugliese Nicola Riccardo
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
Department of Pathology, Cardiology Division, University of Pisa, 56124 Pisa, Italy.
Diagnostics (Basel). 2023 Feb 20;13(4):790. doi: 10.3390/diagnostics13040790.
We explored multiple cardiometabolic patterns, including inflammatory and congestive pathways, in patients with heart failure (HF).
We enrolled 270 HF patients with reduced (<50%, HFrEF; = 96) and preserved (≥50%, HFpEF; = 174) ejection fraction. In HFpEF, glycated hemoglobin (Hb1Ac) seemed to be relevant in its relationship with inflammation as Hb1Ac positively correlated with high-sensitivity C-reactive protein (hs-CRP; Spearman's rank correlation coefficient ρ = 0.180, < 0.05). In HFrEF, we found a correlation between Hb1Ac and norepinephrine (ρ = 0.207, < 0.05). In HFpEF, we found a positive correlation between Hb1Ac and congestion expressed as pulmonary B lines (ρ = 0.187, < 0.05); the inverse correlation, although not significant, was found in HFrEF between Hb1Ac and N-terminal pro-B-type natriuretic peptide (ρ = 0.079) and between Hb1Ac and B lines (ρ = -0.051). In HFrEF, we found a positive correlation between E/e' ratio and Hb1Ac (ρ = 0.203, < 0.05) and a negative correlation between tricuspid annular systolic excursion (TAPSE)/echocardiographically measured systolic pulmonary artery pressure (sPAP) (TAPSE/sPAP ratio) (ρ = -0.205, < 0.05) and Hb1Ac. In HFpEF, we found a negative correlation between TAPSE/sPAP ratio and uric acid (ρ = -0.216, < 0.05).
In HF patients, HFpEF and HFrEF phenotypes are characterized by different cardiometabolic indices related to distinct inflammatory and congestive pathways. Patients with HFpEF showed an important relationship between inflammatory and cardiometabolic parameters. Conversely, in HFrEF, there is a significant relationship between congestion and inflammation, while cardiometabolism appears not to influence inflammation, instead affecting sympathetic hyperactivation.
我们在心力衰竭（HF）患者中探索了多种心脏代谢模式，包括炎症和充血途径。
我们纳入了270例射血分数降低（<50%，HFrEF；n = 96）和保留（≥50%，HFpEF；n = 174）的HF患者。在HFpEF中，糖化血红蛋白（Hb1Ac）似乎与炎症关系密切，因为Hb1Ac与高敏C反应蛋白（hs-CRP）呈正相关（Spearman等级相关系数ρ = 0.180，P < 0.05）。在HFrEF中，我们发现Hb1Ac与去甲肾上腺素之间存在相关性（ρ = 0.207，P < 0.05）。在HFpEF中，我们发现Hb1Ac与以肺B线表示的充血呈正相关（ρ = 0.187，P < 0.05）；在HFrEF中，Hb1Ac与N末端前B型利钠肽之间（ρ = 0.079）以及Hb1Ac与B线之间（ρ = -0.051）虽未发现显著的负相关。在HFrEF中，我们发现E/e'比值与Hb1Ac呈正相关（ρ = 0.203，P < 0.05），三尖瓣环收缩期位移（TAPSE）/超声心动图测量的收缩期肺动脉压（sPAP）（TAPSE/sPAP比值）与Hb1Ac呈负相关（ρ = -0.205，P < 0.05）。在HFpEF中，我们发现TAPSE/sPAP比值与尿酸呈负相关（ρ = -0.216，P < 0.05）。
在HF患者中，HFpEF和HFrEF表型具有与不同炎症和充血途径相关的不同心脏代谢指标特征。HFpEF患者的炎症与心脏代谢参数之间存在重要关系。相反，在HFrEF中，充血与炎症之间存在显著关系，而心脏代谢似乎不影响炎症，而是影响交感神经过度激活。
