| BackgroundWith the development of people’s living standards, health care, medical diagnosis and treatment, life expectancy is longer than the previous significantly. Diagnosis and treatment of many chronic diseases have become challenges to overcome. Chronic heart failure (CHF) is the end stage of most cardiovascular disease. According to incomplete statistics, there are over20million CHF patients worldwide, the overall incidence of which is0.3%to2%, and the5-year survival rate of which is similar to cancer. In China, the rate of CHF in general population is1.9%, and this proportion increases with ages. The proportion of CHF patients is7.4%with people aged over65while10%older than80. So heart failure disease is a big burden on the economy of society and the individual. Heart failure affects about5million Americans. Roughly550,000people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than65. Chronic Heart failure (CHF) refers that the heart muscle can not pump blood around the body effectively. The pathogenesis of CHF is complex and unclear, which is associated with ventricular remodeling, neuroendocrine activation and cytokine system.Brain natriuretic peptide, which is also called B-type natriuretic peptide, is secreted by ventricular myocytes stimulated by lifted perfusion pressure. It is consisted of32amino-acid, and plays a role in diuretic, natriuretic, vasodilation, and against excitation of the renin-angiotensin system and the sympathetic nervous system. Copeptin is located in C-teminal of arginine vasopressin original. Compared with arginine-vasopressin (AVP), it is more stable and easily detected. Some studies have showed that Copeptin, substitute of AVP, is positively related to AVP in serum of different patients. Recently, it has been showed that copeptin has much more valuable in prognosis of advanced heart failure than BNP and NT-proBNP.Objective(1) To investigate the change of serum copeptin and NT-proBNP level in chronic heart failure (CHF) patients, and analyze their value of diagnosis, treatment and prognosis.(2) To analysis the changes of indicators related with heart failure after treatment of Lvosimendan and rh-BNP, and so as to provide a theoretical basis for the clinical treatment of heart failure.MethodThe serum copeptin level was determined by ELISA in300patients with CHF and180controls (control group). Meanwhile, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDd), interventricular septum (IVS) and left ventricular posterior wall at the left ventricular diastasis (LVPW) were detected by echocardiography in all patients. Detection of serum NT-proBNP level was by Rapid heart failure diagnosis apparatus (Biosite, USA). Blood biochemical analysis was performed by AU1000/2700automatic biochemical analyzer. Analysis Correlation between copeptin and these indices, comparing the change of these indices before and after of treatmentResult(1) Generally data showed that compared with the control group, in heart failure group, the proportion of dilated cardiomyopathy, Cys-C, HsCRP, CTNI, NT-proBNP, and copeptin, LAD, LVEDd were significantly increased (P<0.05or P<0.01); while HDL-C, LVEF, IVS levels decreased (P<0.05or P<0.01),(2) The level of Copeptin, NT-proBNP were rised with the elevated NYHA grading (P<0.01), whereas LVEF was decreased. LAD, LVEDd were significantly increased with the elevated NYHA grading (P<0.05), while IVS was dimished.(3) Spearman linear correlation analsis and partial correlation analysis showed that the serum NT-proBNP level was positively with the copeptin level, the echocardiography index of heart failure patients (left ventricule at the end diastolic pressure, left atrium, right ventricule at the end diastolic pressure, right atrium)(r=0.566, P<0.01, r=0.628, P<0.01, r=0.489, P<0.01, r=0.3000.275, P<0.01,r=0.202, P<0.05), while it is negatively correlation with Left ventricular ejection fraction(r=0.275, P<0.01). The serum Copeptin level is positively correlation with left ventricule at the end diastolic pressure, left atrium (r=0.411, P<0.01, r=0.506, P<0.01),but it is negatively correlation with left ventricular ejection fraction(r=-0.185, P<0.01, r=-0.626, P<0.05).(4) Multivariate logistic regression analysis showed the level of serum Copeptin, NT-proBNP and LVEDd were independent risk factors for prediction of Heart Failure patients, in which NT-proBNP was the strongest (P=0.010).(5) Critical values of NT-proBNP and Copeptin were evaluated according to receiver operating characteirces curve (ROC) in CHF. Their sensitivity of diagnosis on CHF were81.55%,98.3%respectively; secificity were77.3%,66.7%respectively; positive predictive value was60.61%,60.85%respectively; the negative predictive value were90.70%,98%respectively.(6) Compared with conventional therapy group, Copeptin and NT-proBNP were significantly decreased in Levosimendan treatment group and rh-BNP grorup (P <0.05); LVEF was significantly increased (P<0.05or P<0.01). Levosimendan treatment group and the rh-BNP group had no significant difference (P>0.05).(7) Rh-BNP could reduce the risk of Cardiovascular Composite Endpoint Event in patients of heart failure, and it was protective factor of patients with heart failure (P=0.028,95%CI0.005-0.740).Conclusion(1) The level of Copeptin and NT-proBNP are rised with the elevated NYHA grading (P<0.01). Critical value of Copeptin is evaluated according to receiver operating characteirces curve (ROC) in CHF. Its sensitivity of diagnosis on CHF is98.3%; secificity is66.7%; positive predictive value is60.85%; the negative predictive value is98%.(2) The copeptin level is positively correlated to the serum NT-proBNP level, while it is negatively correlated with Left ventricular ejection fraction (LVEF). The combined detection of serum Copeptide and NT-proBNP levels of patients with heart failure can be used to assist early diagnosis and evaluate therapeutic and prognosis in patients with heart failure.(3) Changes of serum NT-proBNP concentration can act as a predictor of death in patients with end-stage heart failure.(4) rh-BNP can improve outcome of patients with heart failure, and reduce the risk of death in those patients. |
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