The Changes Of Plasma POSTN And TGF-?1 Levels In Patients Of Chronic Heart Failure With Dilated Cardiomyopathy

Background and ObjectiveThe sudden cardiac death?SCD?and heart failure?HF?are usually caused by dilated cardiomyopathy?DCM?,which is a major indication for heart transplantation in children and adults around the world^[1].The characterization of DCM is the enlargement of the major pump compartment of heart?left ventricle?,or both ventricles get expanded,which is usually accompanied by systolic dysfunction.DCM is the most common type of non-ischemic cardiomyopathy.The clinical characteristics include cardiac enlargement,systolic dysfunction,arrhythmia,heart failure,thromboembolism and SCD.The morbidity of DCM in China is about 13 to 84 per100,000,and the 5-year survival rate after diagnosis is about 50%.Myocardial fibrosis?MF?is the primary pathological feature in DCM,which is caused by the massive accumulation of extracellular matrix?ECM?.When the heart tissue is damaged?such as acute myocardial infarction,ischemia-reperfusion injury,overloaded pressure,etc.?,the damaged tissue recruits a variety of cytokines and factors to get repaired and promote the proliferation of cardiac fibroblasts?CFs?,which results in the secretion of extracellular matrix.Excessive repaired procession will lead to the accumulation of extracellular matrix,which may result in the imbalance of collagen types and promote the process of fibrosis.Myocardial fibrosis is a form of ventricular remodeling.There are a large number of signaling pathways which play promoting function during the process of myocardial fibrosis.POSTN is a latest protein which is mainly expressed and secreted by cardiac fibroblasts.The movement of CFs is affected by POSTN through the relevant AKT and FAK signal pathways.The CFs'function could also be affected by POSTN level.POSTN may play an important role in ventricular remodeling in the heart failure.Transforming growth factor?1?TGF-?1?can be secreted by many types of cells.In the cardiovascular system,it can be secreted by cardiomyocytes and CFs,which may promote the expression of procollagen genes and the synthesis of ECM components^[2].TGF-?1 is a key that mediates cardiac remodeling and plays an important role in the process of heart failure^[3].Related studies show that POSTN is correlated with the TGF-?1 signal pathway^[4].We studied the plasma of POSTN and TGF-?1 levels in patients of chronic heart failure with DCM and analyzed the correlation between POSTN,TGF-?1 and the ventricular remodeling.POSTN may provide a new direction for clinical diagnosis,treatment,and evaluation of patients with heart failure.MethodsWithin 13 month?2017.01-2018.01?,102 patients of DCM with heart failure in the First Affiliated Hospital of Zhengzhou University were recruited in the study group.According to the classification of New York Heart Association?NYHA?,patients were divided into grades??31 cases?,??35 cases?,and??36 cases?.35 subjects were selected as normal control.The clinical data of the two groups were collected.Left ventricular end-diastolic volume?LVEDV?and left ventricular ejection fraction?LVEF?were measured by echocardiography.Enzyme-linked immunosorbent assay?ELISA?was used to examine the plasma levels of POSTN and TGF-?1 in the two groups.Statistical analysis was performed by SPSS21.0 statistical software.The data were analyzed by t-test,analysis of variance,X ² test,Pearson methods.The Bonferroni method was used for comparison between groups.Results1.Compared with the control group,the levels of plasma POSTN and TGF-?1were significantly higher in DCM patients with chronic heart failure,and the difference was statistically significant?P<0.05?.2.The levels of POSTN,TGF-?1,and NT-proBNP in DCM patients with chronic heart failure were higher than in control group,NYHA?>NYHA?>NYHA?group?P<0.01?.The levels of LVEDV in NYHA?,?and?were higher than in the control group,NYHA?,NYHA?>NYHA??P<0.01?,but there was no significant difference between NYHA?and NYHA??P>0.01?.3.Pearson correlation analysis shows that the expression of POSTN and TGF-?1levels were positively correlated in DCM heart failure group?r=0.661,P<0.01?,POSTN was positively correlated with NT-proBNP,LVEDV?r=0.589,0.325,P<0.01?,POSTN was negatively correlated with EF?r=-0.402,P<0.01?.ConclusionPOSTN and TGF-?1 are closely related to the severity of heart failure in patients with DCM.They may be involved in ventricular remodeling and provide new directions for the diagnosis,treatment and prognosis of heart failure in DCM patients.