| Backgroud:Atrial fibrillation(AF)is one of the most common arrhythmia in clinical disease,atrial fibrillation patients often accompanied by high and thromboembolic stroke risk.Chronic heart failure(HF)is the terminal stage of all kinds of cardiovascular disease,along with our country population aging trend of increasingly severe,all kinds of chronic cardiovascular disease incidence is increasing year by year,while with the improvement of medical levels,such as cardiovascular diseases such as hypertension,coronary heart disease early intervention,active treatment,prolong survival time,but the mortality rate of chronic heart failure is still at the higher level.In clinical work,HF and AF often occur together,which is related to similar risk factors and similar pathophysiological changes of the two diseases.At present,more and more studies show that cystatin C can affect the occurrence and development of AF and HF by promoting oxidative stress,inflammatory response and structural remodeling.Mitral flow velocity/mitral annulus velocity(E/e’)in early diastolic period is widely used as an indicator to evaluate diastolic function because of its high accuracy.In patients with AF combined with HF,it is unclear whether changes in cystatin C levels vary depending on the type of AF and severity of heart failure.The aim of this study was to investigate the correlation between cystatin C,E/e and other cardiac ultrasound indicators,to explore the relationship between cystatin C,diastolic function,atrial fibrillation and heart failure,and to provide a reference for the treatment,early prevention and prognosis of patients with atrial fibrillation combined with heart failure.Method:From July 2018 to October 2019,220 patients with non-valvular atrial fibrillation admitted to the Second Hospital of Shandong University were selected as the study group,79 patients with sinus rhythm were selected as the control group,then the risk factors of atrial fibrillation were analyzed.According to different type of atrial fibrillation,the study group was divided into three groups,then Cys-C level and E/e’ratio differences among different groups were analyzed.Finally,220 patients with non-valvular atrial fibrillation were divided into four groups based on NYHA level,The differences of Cys-C level and E/e’ ratio among groups and the relationship between cystatin C,E/e’ and left atrial diameter in patients with chronic cardiac dysfunction with atrial fibrillation were analyzed.ROC curve was drawn to evaluate the predictive value of cystatin C and E/e’ for heart failure in patients with atrial fibrillation.Using binary Logistic regression analysis,the co-predictors of cystatin C and E/e’ for ejection fraction in patients with atrial fibrillation were obtained and ROC curves were drawn to evaluate the predictive value of the co-predictors of cystatin C and E/e’ for ejection fraction decline in patients with AFResults:The analysis results show that the level of urinary inhibition atrial fibrillation group C(P<0.001)and the E/e’ ratio(P<0.001)were significantly higher than that of control group,and after correction related association variable regression analysis found in inhibition C level(OR=0.024,P=0.010)and the E/e’ ratio(OR=1.948,P<0.001)associated with the occurrence of atrial fibrillation,history of cardiac insufficiency,blood uric acid,serum creatinine,left atrial diameter,left ventricular end-diastolic diameter as a risk factor for atrial fibrillation occurred(P<0.05).Cystatin C was linearly correlated with E/e’,left atrial diameter,left ventricular end-diastolic diameter,ventricular septal thickness,and left ventricular posterior wall thickness(P<0.05).The differences of Cys-C,E/e’ and LAD changes among different types of atral fibrillation were analyzed,and it was discovered that there were differences in the Cys-C leve,E/e’ratio and LAD comparison between paroxysmal atrial fibrillation and persistent atrial fibrilllation,permanent atrial fibrillation(P<0.01),however,the The differences of Cys-C level,E/e’ ratio and LAD between persistent atrial fibrillation and permanent atrial fibrillation was not statistically significant.The Cys-C level,E/e’ ratio,LAD,LVEDD,IVST changes among atrial fibrillation with different NYHA levels(P<0.05),and it was discovered that there were differences in the Cys-C level,E/e’ ratio,LAD and LVEDD between atrial fibrillation with heart failure and atrial fibrillation without heart failure(P<0.001).It was discovered that there were differences in the E/e’ratio and LAD comparison between AF-NYHA 1,11 and AF-NYHA III,AF-NYHA IV(P<0.001),but the E/e’ ratio and LAD,but the E/e’ratio between AF without HF and AF-NYHAⅠ,Ⅱ was not statistically significant.Cys-C was linearly correlated with E/e’,LAD,LVEDD,IVST,LVPWT,and LVEF,respectively(r=0.640,P<0.001),(r=0.434,P<0.001),(r=0.399,P<0.001),(r=0.936,P<0.001),(r=0.421,P<0.001),(r=0.421,P<0.001),(r=0.516,P<0.001).Cystatin C(critical value 1.265mg/L,sensitivity 63.6%.specificitv 86.9%.P<0.05)and E/e’(critical value 14.5.sensitivity 68.2%.specificity 77.8%,P<0.05)have predictive value for the occurrence of HFrEF in patients with atrial fibrillation.However,the co-predictors of Cys-C and E/e’(co-predictors=Cys-C+E/e’*0.108)were more sensitive to the occurrence of HFrEF in patients with atrial fibrillation(critical value 2.175,sensitivity 93.2%,specificity 59.1%,P<0.05).Conclusion:Cys-C and E/e’ are risk factors for AF.Cys-C and E/e’ levels are associated with AF type.Cys-C and E/e’ in patients with atrial fibrillation complicated with chronic cardiac insufficiency were valuable.There was an obvious linear relationship between Cys-C and E/e’,left ventricular end diastolic period,ventricular septal thickness,and left ventricular posterior wall thickness.Cys-C combined with E/e’has a high predictive value for HFrEF in patients with atrial fibrillation. |
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