| ObjectiveThe expression differences of human cartilage glycoprotein 39(YKL-40)in peripheral blood were investigated in healthy patients,patients with chronic heart failure(CHF)and patients with CHF complicated with sarcopenia.To explore the correlation between serum YKL-40 and cardiac function and prognosis in elderly patients with CHF complicated with sarcopenia,and to clarify the influencing factors of the occurrence of CHF with sarcopenia.To investigate the correlation between serum YKL-40 and major adverse cardiovascular events(MACEs)in elderly CHF patients with sarcopenia within 6 months after discharge.To clarify the predictive value of serum YKL-40 for MACEs in elderly patients with CHF complicated with sarcopenia within six months after discharge.MethodsAfter examination and approval by the Medical Ethics Committee of Ulanqab Central Hospital,120 elderly patients with CHF were selected as the experimental group,which were treated in the geriatrics department of Ulanqab Central Hospital from December 2021 to June2022.Furthermore,100 health examination patients were collected as the control group,in the physical examination department of Ulanqab Central Hospital during the period.All subjects signed an informed consent form for the study.General data,past history and biochemical indexes of the experimental group and control group were collected,and serum YKL-40 concentration was determined by ELISA.After admission,all patients in the experimental group underwent cardiac ultrasound examination after admission,while muscle mass,grip strength and walking speed were detected by human body component analyzer.According to whether the patients were complicated with sarcopenia,they were divided into 47 patients with CHF sarcopenia group and 73 patients with CHF non-sarcopenia group.At the same time,the general data,biochemical indexes,YKL-40 levels and cardiac function indexes of the two groups were compared.{N-terminal pro Brain Natriuretic Peptide,NT-proBNP),6minutes walking distance(6MWD),Left Ventricular Ejection Fraction(LVEF)},and prognostic indicators.The general data,biochemical indexes and YKL-40 levels of the non-sarcopenia group and the control group were compared.The occurrence of MACEs in the experimental group within 6 months was obtained through outpatient follow-up or communication methods(telephone,SMS,wechat,etc.).Patients with heart failure were divided into a good prognosis group(101 cases)and a poor prognosis group(19 cases)according to whether they had MACEs.The general data,laboratory indicators,YKL-40 levels and cardiac function of the two groups were compared,and the correlation between YKL-40 and the prognosis of elderly patients with CHF was analyzed by Logistic regression.Elderly patients with CHF sarcopenia were divided into MACEs group(12 cases)and non-maces group(35 cases)according to the occurrence of MACEs within 6 months after discharge.Baseline data,YKL-40 level and cardiac function of the two groups were compared.Logistic regression was used to analyze the risk factors of MACEs in elderly patients with CHF sarcopenia within 6 months after discharge,and to explore the predictive factors of MACEs and the correlation between YKL-40 and MACEs.The predictive value of YKL-40 for the risk of MACEs in senile patients with CHF sarcopenia within 6 months after discharge was analyzed by Receiver operating character risticcurve(ROC).Result1.The smoking history rate,diabetes history rate,hypertension history rate,hyperlipidemia history rate,YKL-40 level,NT-proBNP in healthy group were lower than those in senile CHF sarcopenia group and senile CHF non-sarcopenia group(P<0.05).The YKL-40 level and NT-proBNP in the elderly CHF sarcopenia group were higher than those in the elderly CHF non-sarcopenia group,and body mass index(BMI)and albumin were lower than those in the elderly CHF non-sarcopenia group(P<0.05).The BMI of CHF non-sarcopenia group was lower than that of healthy control group(P<0.05).2.In elderly CHF patients,YKL-40 and NT-proBNP in poor prognosis group were significantly higher than those in good prognosis group(P<0.05);The ejection fraction and6 MWD of poor prognosis group were significantly lower than those of good prognosis group(P<0.05).YKL-40,NT-proBNP and 6MWD were significantly correlated with poor prognosis(P<0.05),among which,YKL-40 and NT-proBNP were independent risk factors for poor prognosis(OR > 1),and 6MWD was protective factor for poor prognosis(OR<1).3.The ejection fraction,6MWD and BMI of the elderly CHF sarcopenia group were significantly lower than those of the elderly CHF non-sarcopenia group(P<0.05),and the incidence of adverse events and YKL-40 of the elderly CHF sarcopenia group were significantly higher than those of the elderly CHF non-sarcopenia group(P<0.05).YKL-40 and BMI were significantly correlated with the occurrence of CHF sarcopenia in the elderly(P<0.05).YKL-40 was an independent risk factor for the occurrence of CHF sarcopenia in the elderly(OR > 1),and BMI was a protective factor for the occurrence of CHF sarcopenia in the elderly(OR<1).4.The YKL-40 and NT-proBNP in MACEs group were significantly higher than those in non-Mac Es group(P<0.05).The ejection fraction and 6MWD in MACEs group were significantly lower than those in non-MACEs group(P<0.05).Binary Logistic regression showed that YKL-40,NT-proBNP and 6MWD were significantly correlated with the occurrence of MACEs(P<0.05),among which YKL-40 and NT-proBNP were independent risk factors for the occurrence of MACEs(OR > 1).6MWD was a protective factor affecting the occurrence of MACEs(OR<1).5.The ROC curve was used to predict MACEs of senile heart failure with serum YKL-40.The results showed that the area under the curve of YKL-40,NT-proBNP,6MWD,YKL-40+ NT-proBNP+6MWD was 0.794,0.724,0.724,0.938,respectively.The P values of the test were 0.003,0.022,0.022,< 0.001,and the P values were all less than 0.05,indicating that YKL-40,NT-proBNP,6MWD,YKL-40+ NT-proBNP+6MWD had a certain predictive effect on the occurrence of MACEs in elderly patients with CHF sarcopenia.In comparison,the prediction effect of YKL-40 was better than that of NT-proBNP and 6MWD,and the prediction effect of YKL-40 combined with NT-proBNP and 6MWD was better.Conclusions1.Serum YKL-40 concentration is increased in elderly CHF patients,and the YKL-40 level is higher in elderly CHF patients with sarcopenia.2.Compared with elderly patients with CHF without sarcopenia,elderly patients with CHF combined with sarcopenia have poor cardiac function and poor prognosis,which may be related to the rise of YKL-40.3.Serum YKL-40 is associated with the prognosis of elderly patients with CHF sarcopenia,and is an independent risk factor for the occurrence of CHF complicated with sarcopenia,as well as an independent factor for the occurrence of MACEs in elderly patients with CHF sarcopenia within 6 months after discharge.4.YKL-40 can be used to predict the occurrence of MACEs in elderly patients with CHF sarcopenia within 6 months after discharge,the combination of NT-proBNP and 6MWD has higher predictive value. |
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