Application Of NLR Combined With Noninvasive Hemodynamics Detection In Elderly Patients With Chronic Heart Failure

Research background and purpose:Heart failure is a serious manifestation or final stage of various cardiovascular diseases and is considered to be the last battlefield of cardiovascular diseases.The basic pathophysiology changes to the diastolic or systolic dysfunction of the heart,and the impaired blood pumping function of the heart leads to the failure of the heart pump,so that it cannot meet the metabolic needs of the body tissues.The main clinical manifestations are the reduction of cardiac output and the symptoms and signs of pulmonary circulation or systemic blood stasis.It is estimated that 23 million people worldwide suffer from HF [1],and the total adult prevalence rate in developed countries is 1%-2% [2].Domestic epidemiological data indicate that the prevalence of heart failure in our population is 0.9 %(Male 0.7%,female 1.0%),the incidence rate is 0.7 ‰ ~ 0.9 ‰,and the incidence rate and prevalence rate increase with age[3] 。 With the intensification of China’s population aging and the development of medical and health standards,the life expectancy of patients with various cardiovascular diseases is prolonged,which ultimately leads to an increasing number of elderly patients with heart failure.In addition,heart failure is a complex clinical syndrome involving metabolism,neuroendocrine system,and immune system.Understanding of its pathophysiological mechanism has gone from "water and sodium retention","hemodynamic abnormality" and "neuroendocrine system" "Abnormal activation" process,and in recent years more and more studies have shown that inflammation is also involved in the occurrence and development of chronic heart failure.NLR(neutrophil / lymphocyte ratio)combines two neutrophil and lymphocyteinflammation indicators and is a new type of composite inflammation marker that has been confirmed to be closely related to various cardiovascular diseases [4,5 ].The theoretical basis of noninvasive hemodynamic detection is thoracic electrical bioimpedance measurement.The impedance cardiogram(ICG)is used to describe the hemodynamic state.The basic principle is Ohm’s law.The thoracic cavity can be regarded as an electrical conductor,so the thoracic aorta Changes in blood flow and velocity due to cardiac contraction will inevitably cause changes in electrical conductivity.Using electrode pads to record this change,the hemodynamic information of the human body can be extracted to reflect certain physiological and pathological changes.Some studies have suggested that its correlation with the results of traditional pulmonary hemodynamic dilution method for measuring hemodynamics reaches 0.77 [6].At present,the clinical diagnosis of heart failure depends on symptoms,signs and electrocardiogram,chest radiography,echocardiography,BNP or NT-proBNP,etc.,among which BNP and echocardiography are the first choice.This article aims to study the application value of NLR and noninvasive hemodynamic detection in heart failure,explore its possible mechanism,and analyze its correlation with BNP,in order to provide a new direction for the diagnosis and treatment of heart failure。Methods:1.Heart failure group and no heart failure group: In general data,there is no statistical difference between age,gender,BMI,hypertension,coronary heart disease,diabetes,hyperlipidemia,medication history,LDL-C and other data(P> 0.05);NLR and BNP of NYHA groups of heart failure patients were significantly higher than those of non-heart failure groups(p <0.001),and gradually increased according to NYHA level increase,LVEF was lower than control group;noninvasive hemodynamics Among the parameters,CI,CO,SI,SV,LSW,and LSWI were significantly lower than those without heart failure,and gradually decreased with the increase of NYHA level;TPC and SSVRI were significantly higher than thosewithout heart failure,and increased with NYHA level high and gradually rising,EPCI has no difference.2.Binary logistic analysis: with or without heart failure as the dependent variable,NEU,LYM,NLR,BNP,LVEF,LSWI,LSW,SI,SV,CI,CO,TFC,SSVRI as independent variables,respectively,single factor Binary logistic regression analysis.The results show that NLR,BNP,LVEF,CO,CI,SI,SV,LSW,LSWI,TFC,SSVRI are all meaningful for the diagnosis of heart failure.3.Correlation analysis: There is correlation between NLR and BNP(r = 0.605,p<0.001),ICG parameters CI(r =-0.407,p <0.001),TFC(r = 0.224,p = 0.011),SSVRI(r = 0.268,p = 0.005),LSWI(r =-0.336,p <0.001);there is a positive correlation between NLR,BNP and NYHA levels;TFC and NYHA levels are positively correlated,CI,LSWI and NYHA levels are negatively correlated,SSVRI and NYHA levels are not correlated.4.ROC curve analysis: The results show that the area under the ROC curve(AUC)predicted by NLR is 0.859,the sensitivity is 79.3%,and the specificity is85.7%.The area under the ROC curve predicted by BNP is 0.893,and its sensitivity Was 93.1%,and the specificity was 71.4%.Conclusion:Patients with heart failure have abnormal blood flow.ICG detection can be used to assess the cardiac function of patients with CHF.The detection parameters are related to NLR,and NLR is related to BNP.Therefore,NLR and non-invasive hemodynamic testing can be used for cardiac function assessment in elderly CHF.