Correlation Between Monocyte To HDL Cholesterol Ratio And B-type Natriuretic Peptide In Patients With Preserved Ejection Fraction Heart Failure And 2 Type Diabetes Mellitus

BackgroundHeart failure with preserved left ventricular ejection fraction(EFPHF),which is called the diastolic heart failure too,occurs in 40 to 71% of the patients with HF,with a prognosis which is similar to HF with reduced ejection fraction(HFrEF).HFpEF pathophysiology is different from that of HFrEF,and has been characterized with diastolic dysfunction.Although the treatment of EFpHF has made great progress,its pathogenesis and pathophysiology are unclear.Diabetes mellitus occurs in majority cases with HFpEF worldwide.Patients are mostly older and the increasing incidence of hypertension,hyperlipidemia,obesity and cardiovascular disease,there is still a high morbidity and mortality.With the progress of social aging,It is expected that in the next decade HFpEF will become a dominant cause for heart failure worldwide,Type 2 diabetes mellitus(2DM)is a common complication of EFpHF.The patients with EFpHF and diabetes has many immune inflammatory factors compared with the patients only have EFpHF.The clinical features are serious state,poor effect and complex complication on DM-EFpHF patients.EFpHF is a disease characterized by immune activation and chronic inflammation.Circulating monocytes account for the major source of various proinflammatory and prooxidant factors and interact with endothelial cells and platelets leading to inflammation,thrombosis and endothelial dysfunction,it also promote thrombosis and participate in the pathophysiological process of coagulation.High density lipoprotein cholesterol is a family of lipoprotein particles,mainly composed of protein and lipid composition,HDL-c represents well-known anti-inflammatory and antioxidant as well as antithrombotic effects.As well,HDL-cholesterol has a close interaction with mono-cytes through suppressing monocyte activities,interrupting differentiation of monocytes to macrophages which results in a restricted inflammatory response.Monocyte to HDL-c Ratio(MHR)is a recently emerging indicator of anti-inflammatory and antioxidant activity in tissues.A large number of studies have shown that inflammatory response plays an important role in the development of EFpHF.However,there is no report about the change of MHR and its relationship with the severity of heart failure in patients of type 2 diabetes mellitus with EFpHF.ObjectiveTo explore the diversification of the MOnocyte to HDL Cholesterol Ratio(MHR)、NT-proBNP、hs-CRP level in Diabetes Mellitus patients with Preserved Ejection Fraction Heart Failure(DM-EFpHF),and the relevance between the MHR and NT-proBNP,HbA1 c,hs-CRP level.So as to offer information to determine the treatment,the severity and prognosis in the patients.Material and methods115 hopitalized patients with EFpHF admitted from March 2015 to September 2016 in the Department of Cardiology,The First Affiliated Hospital of Zhengzhou University were selected as research objects.The patients were divided into two groups according to whether combined diabetes or not:with Diabetes Mellitus EFpHF groups(n=61)and simple EFpHF groups(n=54).The level of blood routine examination,clinical bioehemical:cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDLC),high density lipoprotein cholesterol(HDL-c),Uric Acid(UA),creatinine(Cr)and other biochemical indicators were measured by the clinical laboratory testing center.NT-proBNP,HbA1 c,hs-CRP were collected and related Echocardiography indexes wee obtained,then contrasted between two groups,the relevance between MHR and NT-proBNP,HbA1 c,hs-CRP was also analyzed.Statistical analyses were performed using SPSS software version 20.0.Measurement data were first carded normality test.Continuous variables are expressed as the mean ± standard deviation.Categorical data are presented as proportions.between the two groups were compared using t test,The Pearson correlation analysis was used to assess the relation between two quantitative variables with normal distributions.A P<0.05 were considered statistically significant.Results1.The MHR were significantly increased in DM-EFpHF group than that of EFpHF group,There was significant difference between two groups(P<0.05).2.Comparing with simple EFpHF group there were significant increase in MO,NT-proBNP level,MHR,HbA1 c and hs-CRP in DM-EFpHF group(MO)(0.68±0.22 VS 0.58±0.18,P<0.05),NT-proBNP(4730.23±3078.08 VS 3719.24±1639.92,P<0.05),hs-CRP(6.18±2.71 VS 4.67±2.52,P<0.05),HbA1c(7.56±0.93 VS 5.96±0.46,P<0.05).There was significant difference between two groups3.MHR is positively correlating with NT-proBNP(r=0.406,P<0.05),HbA1c(r=0.471,P<0.05)and hs-CRP(r=0.318,P<0.05).but no significant differences are observed between MHR,NT-proBNP and hs-CRP in simple EFpHF group Conclusion1.MHR of the EFpHF patients with type 2 diabetes mellitus group was higher than that of the EFpHF patients without diabetes group.2.MHR is siginificantly increasing and closely related to the hs-CRP in DM-EFpHF patients and can be used an an indicator of oxidative stress,is closely related to the inflammatory response.3.MHR is siginificantly increasing and closely related to the level of NT-proBNP in DM-EFpHF patients.MHR may become a indicator to assess the disease severity in the EFpHF patients with type 2 diabetes mellitus.