| Objective To investigate the changes of serum GDF-15,P?CP and P?NP levels in patients with heart failure and the relationship with the related indexes of Doppler echocardiography,and discuss the value of evaluating the severity of heart failure and ventricular remodeling;To explore the value of GDF-15,P?CP and P?NP in diagnosis and prognosis of heart failure.Method Patients were selected from the department of cardiology at Tianjin Union Medical Center over the period January 2014 to June 2016.A total of 219 participants were divided into four groups which were composed of the different stages of HF.moreover,32 healthy subjects were served as control group.To investigate the changes of serum GDF-15,P?CP,P?NP and NT-pro BNP levels in patients with heart failure and their relationship with the related indexes of Doppler echocardiography,and discuss the value of evaluating the severity of heart failure and ventricular remodeling in groups;To explore the value of GDF-15,P?CP and P?NP in diagnosis and prognosis of heart failure.Results(1)The levels of serum GDF-15,P?CP and P?NP in the HF group were higher than those in control group,and increased significantly with the increase of NYHA cardiac function classification(P<0.05).(2)The levels of serum GDF-15,P?CP,P?NP increased with the increase of heart failure staging.The difference was statistically significant(P<0.05).(3)The levels of serum GDF-15,P?CP and P?NP increased with the decrease of LVEF,the difference was statistically significant(P<0.05).(4)The levels of serum GDF-15,P?CP and P?NP increased with the decrease of e GFR in different renal function groups,the difference was statistically significant(P<0.05).(5)The levels of GDF-15,P?CP and P?NP increased with the increase of LVEDD in different LVEDD groups,the difference was statistically significant(P<0.05).(6)The measured AUC by GDF-15?P?CP?P?NP were 0.787(95% confidence interval: 0.696 to 0.878,P<0.01),0.886(95%confidence interval:0.840 to 0.932,P<0.01),0.921(95% confidence interval: 0.884 to 0.957,P<0.01),The measured AUC by NT-pro BNP was 0.956(95% confidence interval: 0.931 to 0.981,P<0.01).When GDF-15?P?CP?P?NP and NT-pro BNP taken 141.46 pg/ml,122.28ng/ml,0.89ng/ml,337.55pg/ml as cut-off point,they were the best threshold valure of the Judgment of structural heart failure.(7)The measured AUC by GDF-15?P?CP?P?NP were 0.795(95% confidence interval: 0.727 to 0.864,P<0.01),0.876(95% confidence interval : 0.828 to 0.923,P<0.01),0.954(95% confidence interval: 0.930 to 0.979,P<0.01),The measured AUC by NT-pro BNP was 0.942(95% confidence interval: 0.911 to 0.972,P<0.01).When GDF-15?P?CP?P?NP and NT-pro BNP taken 143.56 pg/ml,143.15ng/ml,0.89 ng/ml,1017.50 pg/ml as cut-off point,they were the best threshold valure of the Judgment of symptomatic heart failure.(8)The measured AUC by GDF-15?P?CP?P?NP were 0.656(95% confidence interval: 0.549 to 0.764,P<0.01),0.695(95% confidence interval: 0.609 to 0.781,P<0.01),0.703(95% confidence interval: 0.617 to 0.788,P<0.01),The measured AUC by NT-pro BNP was 0.800(95% confidence interval: 0.721 to 0.879,P<0.01).When GDF-15?P?CP?P?NP and NT-pro BNP taken 409.98 pg/ml,187.41ng/ml,1.02ng/ml,3455.50 pg/ml as cut-off point,they were the best threshold valure of the adverse cardiac events.(9)The incidence of adverse events,SHFM life expectancy and LVEDD in high GDF-15,P?CP and P?NP groups were significantly higher than those in low GDF-15,P?CP and P?NP groups.(10)The level of GDF-15?P?CP?P?NP?NT-pro BNP?LVEDD in adverse cardiac events group were significantly higher than that in the none adverse cardiac events group.(11)GDF-15,P?CP and P?NP were positively correlated with NT-pro BNP,LVEDD and LVM? respectively,and negatively correlated with LVEF.Conclusion(1)The levels of serum GDF-15,P?CP,P?NP began to increase in the early stages of heart failure and were positively correlated with LVEDD and LVM?,suggesting that they are closely related to ventricular remodeling and may help screen for early heart failure.(2)The levels of serum GDF-15,P?CP,P?NP increased with the increase of heart failure staging and cardiac function classification,and positively correlated with NT-pro BNP and negatively correlated with LVEF.They can help NT-pro BNP determine the severity of heart failure.(3)According to the ROC curve,serum GDF-15,P?CP,and P?NP levels have a diagnostic value for ventricular remodeling(AUC=0.787,0.886,0.921).The best cut-off values for ventricular remodeling were 141.46 pg/ml,122.28 ng/ml,0.89 ng/ml,respectively.(4)According to the ROC curve,serum GDF-15,P?CP,and P?NP levels can be used as predictors of prognosis in patients with heart failure(AUC=0.656,0.695,0.703).The best cut-off values for estimating clinical endpoint events were 409.98 pg/ml,187.41 ng/ml,1.02 ng/ml,respectively,and all three indicators were consistent with the SHFM prediction. |
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