Berezin Alexander A, Obradovic Anica Babic, Fushtey Ivan M, Berezina Tetiana A, Lichtenauer Michael, Berezin Alexander E
Department of Internal Medicine, Zaporozhye Medical Academy of Postgraduate Education, 69096 Zaporozhye, Ukraine.
Medical Practice for General Medicine, 22111 Hamburg, Germany.
J Cardiovasc Dev Dis. 2023 Mar 23;10(4):136. doi: 10.3390/jcdd10040136.
The aim of this study was to determine the discriminative value of irisin for acutely decompensated heart failure (ADHF) in type 2 diabetes mellitus (T2DM) patients with chronic HF. We included 480 T2DM patients with any phenotype of HF and followed them for 52 weeks. Hemodynamic performances and the serum levels of biomarkers were detected at the study entry. The primary clinical end-point was ADHF that led to urgent hospitalization. We found that the serum levels of N-terminal natriuretic pro-peptide (NT-proBNP) were higher (1719 [980-2457] pmol/mL vs. 1057 [570-2607] pmol/mL, respectively) and the levels of irisin were lower (4.96 [3.14-6.85] ng/mL vs. 7.95 [5.73-9.16] ng/mL) in ADHF patients than in those without ADHF. The ROC curve analysis showed that the estimated cut-off point for serum irisin levels (ADHF versus non-ADHF) was 7.85 ng/mL (area under curve [AUC] = 0.869 (95% CI = 0.800-0.937), sensitivity = 82.7%, specificity = 73.5%; = 0.0001). The multivariate logistic regression yielded that the serum levels of irisin < 7.85 ng/mL (OR = 1.20; = 0.001) and NT-proBNP > 1215 pmol/mL (OR = 1.18; = 0.001) retained the predictors for ADHF. Kaplan-Meier plots showed a significant difference of clinical end-point accumulations in patients with HF depending on irisin levels (<7.85 ng/mL versus ≥7.85 ng/mL). In conclusion, we established that decreased levels of irisin were associated with ADHF presentation in chronic HF patients with T2DM independently from NT-proBNP.
本研究旨在确定鸢尾素对2型糖尿病（T2DM）合并慢性心力衰竭（HF）患者急性失代偿性心力衰竭（ADHF）的鉴别价值。我们纳入了480例患有任何HF表型的T2DM患者，并对他们进行了52周的随访。在研究开始时检测血流动力学指标和生物标志物的血清水平。主要临床终点是导致紧急住院的ADHF。我们发现，ADHF患者的N末端脑钠肽前体（NT-proBNP）血清水平较高（分别为1719[980 - 2457]pmol/mL和1057[570 - 2607]pmol/mL），而鸢尾素水平较低（4.96[3.14 - 6.85]ng/mL和7.95[5.73 - 9.16]ng/mL）。ROC曲线分析显示，血清鸢尾素水平（ADHF与非ADHF）的估计截断点为7.85 ng/mL（曲线下面积[AUC]=0.869（95%CI = 0.800 - 0.937），敏感性 = 82.7%，特异性 = 73.5%；P = 0.0001）。多因素逻辑回归分析得出，血清鸢尾素水平<7.85 ng/mL（OR = 1.20；P = 0.001）和NT-proBNP>1215 pmol/mL（OR = 1.18；P = 0.001）仍是ADHF的预测指标。Kaplan-Meier曲线显示，根据鸢尾素水平（<7.85 ng/mL与≥7.85 ng/mL），HF患者的临床终点累积情况存在显著差异。总之，我们证实，在T2DM合并慢性HF患者中，鸢尾素水平降低与ADHF的发生相关，且独立于NT-proBNP。
