Adiponectin In Heart Failure With Normal Ejection Fraction

Background Heart failure with normal ejection fraction (HFNEF) constitutes nearly half of all HF patients and is associated with high morbidity and mortality. The prognosis of patients with HFNEF was similar to those with systolic dysfunction. Desipite the high prevalence of this syndrome, very little information is known regarding its mortality and morbidity, or the efficacy of drugs. Adiponectin, a recently discovered adipocyte-derived peptide, is involved in the regulation of insulin sensitivity and lipid oxidation and, purportedly, in the development of atherosclerosis and coronary heart disease in humans. Several prospective studies have assessed the association between adiponectin levels and HF. High levels are associated with increased mortality and severity in patients with HFREF, very little information is known regarding the patients with HFNEF.Objectives:The purpose of this study was to compare the clinical characteristic and prognosis among consecutively hospitalized patients with CHF and preserved ejection fraction versus reduced ejection fraction; and to determine concentrations of adiponectin(APN) in heart failure with normal ejection fraction(HFNEF) patients and heart failure with reduced ejection fraction(HFREF)patients, determine its predictive value on outcome in patients with HFNEF, and to find out the prognostic indicators in HFNEF.Methods:The study sample included 190 patients with CHF and 80 control patients without heart failure who were hospitalized during the past 2-year period. The CHF patients were classified into 2 groups according to "ESC 2007 Association consensus for the diagnosis of heart failure with normal ejection" :HFNEF group(n=70), HFREF(n=120) group and control group(n=80). All the selected patients were asked the medical history, paysical examination, laboratory tests and echocardigraphic examinations. Excluded congenital cardiovascular disease, pericardial disease, chronic respiratory disease, valvular heart disease, autoimmune disease, malignant tumor and renal insufficiency. Compare the clinical characteristic and prognosis between the two groups. Serum and clinical data were obtained for patients with HFNEF group,HFREF group and non-HF control group. Serum concentrations of APN, N-terminal pro-brain natriuretic peptide (NT-proBNP) were determined, doppler echocardiography were measured after admission. Following-up the death and readmission of time and number of each group by telephone.Result:1.In all patients with chronic heart failure, the proportion of HFNEF is 37%. HFNEF patients were more often women, had a higher level of BMI and a higher prevalence of hypertention.2.Concentrations of APN in patients with HFNEF were significantly lower than patients with HFREF, both HFNEF and HFREF group are higher than control group(8.13±2.48μg/ml vs 12.34±4.78μg/ml vs 5.45±1.34μg/ml, P<0.01). Also, Concentrations of NT-proBNP in patients with HFNEF were significantly lower than patients with HFREF, but higher than control group (1987±748 pg/ml vs 2507±985 pg/ml vs 80±23 pg/ml, P<0.01); Concentrations of hs-CRP in heart failure patients were higher than control group(8.62±13.3 mg/l vs 8.79±6.96 mg/l vs 1.92±2.31 mg/l, P<0.01).3.Plasma APN concentration in HFNEF is positively correlated with NYHA classification, hs-CRP, NT-proBNP concentration and LVMI(R=0.484, P=0.001;R=0.312, P=0.038;R=0.868, P=0.000;R=0.350, P=0.000); 4.Concentrations of APN and NT-proBNP in patients with HFNEF were elevated with the elevation of NYHA classification; 5.The occurrence of cardiovascular events in HFNEF group is 44.29% and 48.33% in HFREF group (P=0.193); no difference was found between the 2 group in the mortality rate(P=0.248), and readmission rates(P=0.893).6.The results of a multivariate analysis using a Cox proportional hazards model to identify predictors of the prognosis of heart failure revealed NYHA classification,hs-CRP,NT-proBNP and APN were identified as independent predictors of cardiovascular events rate in HFNEF (P=0.045;P=0.043; P=0.001; P=0.020).Conclusion:1.In all patients with chronic heart failure, the proportion of HFNEF is 37%. HFNEF patients were more often women, had a higher level of BMI and a higher prevalence of hypertention.2. Concentrations of APN in patients with HFNEF were significantly lower than patients with HFREF(P<0.01); both of the groups were higher than control group(P<0.01); and concentrations of APN and NT-proBNP in patients with HFNEF were elevated with the elevation of NYHA classification; 3. Plasma APN concentration in HFNEF is positively correlated with NT-proBNP concentration.4. The prognosis of HFNEF was similar to those with HFREF. NYHA classification,hs-CRP,NT-proBNP and APN are independent predictors of cardiovascular events rate in HFNEF.