| Background and ObjctiveChronic heart failure is the end stage of all kinds of cardiac diseases. The morbidity and mortality increases year by year, so early diagnosis and rapid assessment of the severity of heart failure might play a very important role in treatment and prognosis. It is clear that the pathophysiological basis of chronic heart failure is ventricular remodeling. Follistatin-like protein 1(FSTL1) is an extracellular glycoprotein secreted by myocardial cells. Recent work suggests that follistatin-like protein 1 is secreted in response to ischemic injuries and that its over expression is protective in the heart and vasculature. FSTL1 played myocardial protection and resistance to apoptosis by activating signal transduction pathway. Galectin-3 is a soluble galactoside binding protein secreted by activated macrophages. Numerous experimental studies have shown that Galectin-3 as the inflammatory mediators involved in the development of myocardial fibrosis and heart failure. In recent years, these two paramaters have become the concern of serum markers of cardiovascular disease, but the research was rare in children with chronic heart failure. The aim of this study is to measure the serum levels of FSTL1 and Galectin-3 in children with chronic heart failure, and to analyze the correlation with New York Heart Association functional class(NYHA), amino-terminalpro-brain natriureticpeptide(NT-Pro-BNP) and the indicators of ventricular remodeling, and to evaluate the clinical value and significance of FSTL1 and Galectin-3 in children with chronic heart failure. MethodsA total number of 45 children with chronic heart failure(CHF) treated from November 2013 to November 2015 in the first Affiliated Hospital of Zhengzhou University were selected as the Chronic Heart Failure group, among whom 21 had endocardial fibroelastosis(EFE) and 24 had dilated cardiomyopathy(DCM). According to the cardiac functional grading standard, the CHF group was divided into three groups: 10 patients with cardiac function of grade-II, 18 patients with cardiac function of grade-III, and 17 patients with cardiac function of grade-IV. Another 30 healthy children were selected as the control group. Enzyme-linked immunosorbent assay was applied to measure the serum levels of FSTL1 and Galectin-3, and radioimmunoassay was applied to measure N-terminal pro-brain natriuretic peptide. Echocardiography was applied to measure the indicators of left ventricular remodeling, such as left ventricular end-diastolic diameter, inter-ventricular septum thickness, left ventricular posterior wall thickness, and left ventricular ejection fraction, left ventricular fraction shortening.SPSS 21.0 statistical software was used for data analysis. Normally distribution of measurement data using mean ± standard deviation, t-test was used to compare the two groups, among the groups were compared by using one-way ANOVA analysis of variance; non-normal distribution of measurement data using median(inter-quartile range), indicates between the two groups were compared using Mann-Whitney U test. Count data using the number of cases, between the two groups were compared using the χ2 test. Correlation analysis using Pearson correlation or Spearman rank correlation analysis. P <0.05 was considered statistically significant. Results1. The CHF group before treatment had a significantly higher serum levels of FSTL1, Galectin-3, NT-pro-BNP[Concentrations were 1763.61 ± 645.30, 221.14 ± 77.66, 7690.00(3189.00~13267.00)] than the control group(Concentrations were 440.17 ± 186.51, 72.89 ± 16.28, 89.73 ± 33.22)(t or Z=10.91, 10.29,-4.39, P<0.05), and higher than after treatment[Concentrations were 535.00(402.50~806.25), 99.40(81.17~166.10), 3157.00(1587.00~4630.50)](Z or t =-5.84, 12.32,-5.92, P<0.05).2. Serum FSTL1, Galectin-3 and NT-pro-BNP levels in three different cardiac function[Concentrations of cardiac function of grade-II were 967.50 ± 430.97, 139.37 ± 32.53, 6139.40 ± 4673.81, concentrations of cardiac function of grade-III were 1653.61 ± 289.33, 200.56 ± 46.04, 6549.00(4154.50 ~ 10703.50), concentrations of cardiac function of grade-IV were 2348.38 ± 422.69, 291.04 ± 62.37, 13118.00(5882.50 ~ 15000.00)]were significantly higher than the control group(F or χ2=49.22, 62.55, 53.68, P<0.05), and pairwise comparison differences among different heart function classification groups were statistically significant(P<0.05).3. The serum levels of FSTL1 and Galectin-3 showed no significant difference between the EFE group(Concentrations were 1623.60 ± 491.96 ng / L, 208.52 ± 76.92 ng / L) and DCM group(Concentrations were 1886.15 ± 743.39 ng / L, 231.19 ± 78.22 ng / L)(t=1.375, 1.020, P> 0.05).4. Serum level of FSTL1 was positively correlated with Galectin-3(r=0.523,P<0.05).5. Serum level of FSTL1 was positively correlated with left ventricular end-diastolic diameter(r=0.485, P=0.001), left ventricular mass(r=0.322, P=0.031), left ventricular mass index(r=0.353, P=0.017), cardiac function(r=0.814, P=0.000), and N-terminal pro-brain natriuretic peptide(r=0.562, P=0.000), and was negatively correlated with left ventricular ejection fraction(r=-0.436, P=0.003) and left ventricular minor axis decurtation rate(r=-0.436, P=0.003). Serum level of Galectin-3 was positively correlated with left ventricular end-diastolic diameter(r=0.527, P=0.000), left ventricular mass(r=0.528, P=0.000), left ventricular mass index(r=0.346, P=0.020), cardiac function(r=0.792, P=0.000), and N-terminal pro-brain natriuretic peptide(r=0.562, P=0.000), and was negatively correlated with left ventricular ejection fraction(r=-0.590, P=0.000) and left ventricular minor axis decurtation rate(r=-0.557, P=0.000). Conclusion1. Elevated serum FSTL1 and Galectin-3 in patients with chronic heart failure were associated with left ventricular remodeling.2. The serum levels of FSTL1 and Galectin-3 can be used as objective indices for clinical diagnosis and severity assessment of CHF in children. |
