Plasma Soluble(Pro)Renin Receptor Level Increases In Patients With Chronic Systolic Heart Failure As The NYHA Cardiac Function Classification Upgrades

Background:In the pathophysiology of chronic heart failure,the heart can undergo cardiac remodeling in response to high load or myocardial damage due to myocardial infarction or other causes.RAS(renin-angiotensin system)plays an important role in cardiac remodeling and the onset of heart failure.The traditional view is that RAS only play a role through Ang?(angiotensin ?),Ald(Aldosterone).In 2002,Nguyen G discovered the renin receptor(precursor)[(P)RR].Many clinical studies have shown that(P)RR level can reflect the severity of certain diseases,such as kidney disease,gestational hypertension,gestational diabetes mellitus,obstructive sleep apnea syndrome.But there is little research on s(P)RR and heart failure.Whether(P)RR can be overexpressed in the patients with heart failure,and whether it is related to NYHA cardiac function classification,are not clear.Objective:This study focused on whether the s(P)RR level of patients with heart failure was elevated and whether the s(P)RR level was associated with NYHA heart failure classification.Metheds:A total of 61 patients with heart failure who were admitted to Heart internal medicine and 19 age-matched healthy subjects in the First Affiliated Hospital of Dalian Medical University from June 2015 to November 2015.The patients with heart failure were divided into three subgroups according to NYHA classification.We also devided the heart failure with renal dysffuction patients(n=26)into two groups.The history and general information of the patients were collected.Brain natriuretic peptide(BNP),serum creatinine(Scr),uric acid(UA),angiotension?(Ang?),Ang?,Ald were measured.The plasma levels of s(P)RR and renin concentrations were evaluated by ELISA kits.All the patients received transthoracic echocardio-graphy(TTE),the left atrial diameter(LAD),left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI)were obtained.SPSS21.0 statistical software was applied to analysis the data.One-Way ANOVA or Chi-square test was used to analyze the difference between groups.Spearman's correlation factor analysis was used to assess the association between s(P)RR,renin and various clinical parameters.Multiple regression analysis was used to evaluate the independent determinants of s(P)RR,P-value<0.05 was considered to be statistically significant.Results:There were significant differences in LAD,LVDs,LVEF and LVMI between the heart failure group and the control group(p<0.05).B group,C group,D group,the above indicators were not statistically significant.The levels of s(P)RR in group D were significantly higher than those in control group(p<0.05).C group and D group were significantly higher than those in group A,but there was no significant difference between the two groups.There was no significant difference in sPRR between group A and group B(p>0.05).The s(P)RR level in group ? was significantly higher than that in group a(p<0.05).There was no significant difference in eGFR between group a and group ?.Spearman correlation factor analysis showed that s(P)RR was positively correlated with NYHA cardiac function grade,BNP,LVMI,Scr,UA and Ang?,and negatively correlated with eGFR,LVEF.Using s(P)RR as the dependent variable,multiple linear regression analysis showed that s(P)RR was independently positively correlated with NYHA cardiac function grade.Conclusions:1.The level of s(P)RR in patients with NYHA class ? was not higher than that in patients with normal heart function,but the level of s(P)RR was further increased as NYHA cardiac function classification upgraded.2.There was a positive correlation between s(P)RR and NYHA cardiac function classification,BNP,LVMI,Scr,UA,Ang? in patients with chronic heart failure,and negatively correlated with eGFR and LVEF.3.NYHA cardiac function classification level is an independent correlation factor of s(P)RR.