The Level Of SST2 In The Plasma Of Elderly Patients With Heart Failure And The Predictive Value Of Death

Colon activelyHeart Failure(HF)is a clinical syndrome at the end of the development of heart disease.Due to the aging of the population,the incidence and mortality of heart failure is increasing,which reduces the life quality of the patients and brings heavy burden to the society and family.In recent years,it has been found that the expression level of sST2 increases when myocardial cells are under traction injury,which accelerates myocardial remodeling and leads to heart failure or gravity dysfunction.Studies have shown that the levels of soluble ST2(sST2)in plasma of patients with heart failure are associated with the prognosis,but few studies of sST2 are involved in the heart failure of elderly patients.This study by collecting the clinical data of elderly patients with heart failure in Affiliated Hospital of Chengde Medical College from December2015 to December 2017,and analyzes its etiology characteristics.sST2levels were measured from December 2015 to December 2016 were collected in the plasma of patients,to investigate the relationship between sST2 and heart failure of elderly patients.And the patients are followed up for one year,and to study the predictive value for death within one year.Part one:The analysis of etiology characteristics in elderly patientswith heart failureObjective:To investigate the etiology features of elderly heart failure by collecting clinical data of elderly heart failure.Methods:The data of 576 patients with heart failure(≥60 years old)hospitalized in our hospital from December 2015 to December 2017 are collected,including their age,gender,body mass index,blood biochemistry,electrocardiogram,echocardiography and other indicators.The analyses are conducted on the clinical characteristics and the differences by means of SPSS24.0 software.P<0.05 was statistically significant.Results:1 The age of patients range from 60 to102 years old,with an average of76.4±12.2 years old.Among them,342 cases are male patients(59.4%)with an average age of 77.5±11.4,and 234 female cases(40.6%)with 75.3±10.1.There were 302 cases of coronary heart disease(52.4%),123 cases of hypertension(21.3%),69 cases of dilated cardiomyopathy(11.2%),12 cases of rheumatic heart disease(2.1%),21 cases of non-rheumatic valvular disease(3.6%),18 cases of hypertrophic cardiomyopathy(3.1%),12 cases of alcoholic cardiomyopathy(2.1%)and other 19 cases(3.3%).2 At the time of admission,an electrocardiogram(ECG)showed 153patients(26.6%)had atrial fibrillation disease or had a history of atrial fibrillation,with the mean age of 78.2±9.8.The average age of patients without atrial fibrillation was 74.4±11.4,and the age difference between two kinds of patients was statistically significant.3 The main risk factors of heart failure were:179 patients with smoking or long-term smoking history(30.1%),121 patients with drinking alcohol(21.0%),overweight patients with(BMI≥24kg/m~2)182 cases(31.6%),and patients with heart failure with high blood pressure 323 patients with high blood pressure(56.1%),patients with diabetes There were 132 cases with hyperlipidemia(22.9%),102 cases with PH,157 cases with history of myocardial infarction or revascularization of blood vessel(22.9%),118 cases with history of stroke(20.5%),41 cases with chronic nephropathy(7.1%),and98 cases with anemia(17.0%).Conclusion:1 The average age of men is higher than that of women,the proportion of elderly patients with heart failure aged 75-89 years is the highest.2 Coronary heart disease is the main cause of heart failure in elderly patients,followed by hypertensive heart disease.The heart failure caused by non-rheumatic valvular heart disease is significantly higher than that caused by rheumatic valvular heart disease.3 The age of patients with atrial fibrillation or with a history of atrial fibrillation is higher than that of patients without atrial fibrillation.4 The main risk factors for elderly patients with heart failure are smoking,drinking and being overweight,and the main associated diseases are high blood pressure,diabetes,hyperlipidemia,pulmonary hypertension,stroke.Part Two: The level of soluble ST2 in the plasma of elderly patients with heart failure and the predictive value for deathObjective: It is to detect the sST2 levels in the serum of elderly patients with heart failure,to explore the relationship between sST2 and heart failure,and after 1 year follow-up,to analyze the predictive value of sST2 in the plasma for death.Method: 378 cases of patients with chronic heart failure over 60 years old in our hospital,from December 2015 to December 2017 in the first part,are considered as the subjects in the study.They are admitted to hospital and their venous bloods are obtained within 24 hours.The enzyme-linked immunosorbent assay is used to determine the sST2 level in plasma and N-terminal pro-B-type natriuretic peptide level(NT-pro BNP)when the patients are hospitalized.After the patient was discharged from the hospital,the patient was followed up by telephone,outpatient service or the case study,and the continuous system was followed up for 1 year,and the endpoint was all due to death.SPSS24.0、Stata14.0 software was used to analyze the differences and P<0.05 was statistically significant.Results: 1 Among 378 cases of heart failure,87 cases died,291 cases survived and 5 cases were lost in the follow-up.2 The sST2 level in plasma of patients was positively correlated with the level of NT-pro BNP and the classifications of cardiac function.The single factor analysis of patients death within 1 year showed that the increase of sST2 level in plasma and NT-pro BNP,the growth of age and the decrease of ejection fraction were associated with the risk of death(P< 0.001).3 Multiple factors Cox regression model analysis showed that the baseline sST2 level of patients was significantly associated with death after adjusting age,NT-pro BNP,ejection fraction and other factors.4 The area under the ROC curve(AUC=0.859)for the prognosis of sST2 was similar to that of NT-pro BNP(AUC=0.852),and there was no statistical difference.The effect of the combined prediction of the two(AUC=0.901)was obviously improved(P< 0.05).5 The survival curves of different levels of sST2 were drawn by Kaplan-Meier method.The survival time of patients below 5547pg/ml was longer.Log-rank test showed that there was a statistically significant difference between them(P< 0.001).Conclusions: 1 The sST2 participates in the occurrence and development of heart failure,and the sST2 level in plasma of patients with heart failure is positively related to the degree of clinical condition and the level of NT-pro BNP.2 sST2 can be used as an independent predictor of death risk in elderly patients with heart failure.