| BackgroundAcute Myocardial Infarction(AMI)is a clinically common critical cardiovascular disease,often associated with Acute Heart Failure(AHF).The incidence of AHF within one week after AMI is as high as 32%-48%.Due to the Acute onset of AHF after AMI and the low specificity of early clinical manifestations,early diagnosis and treatment is extremely important for its prognosis.Studies have shown that serum carbohydrate antigen 125(CA125)level is associated with cardiac systolic dysfunction in patients with Chronic Heart Failure(CHF).However,the value of CA125 in predicting AHF after AMI has not been determined yet.This study aims to evaluate the predictive value of serum CA125 and combined b-type brain natriuretic peptide(BNP)in predicting the early occurrence of AHF after AMI,so as to provide a new clinical diagnostic index.ObjectiveBy detecting AHF after AMI patients and patients with AHF group serum carbohydrate antigen(CA125)and brain natriuretic peptide(BNP)level,combination of color doppler echocardiography parameters and laboratory test results,CA125 combine the BNP levels in patients with AMI AHF happened within one week and predictive value and the severity of coronary artery lesion degree of correlation.Methods124 AMI patients admitted to the department of cardiovascular medicine of zhengzhou people's hospital from January 2017 to December 2018 were selected according to the diagnostic and treatment guidelines for acute st-elevation myocardial infarction published by the European society of cardiology(2017),including 68 cases of acute st-elevation myocardial infarction and 56 cases of acute non-st-elevation myocardial infarction.In the morning after admission,venous blood was taken on an empty stomach on the following morning,and serum was isolated for laboratory examinations such as CA125,BNP,c-reactive protein(CRP),blood urea nitrogen(BUN),uric acid(UA),serum creatinine(SCr),cardiac troponin I(cTnI),etc.CA125 was determined by chemiluminescent microparticle immunoassay and abbott I2000 diagnostic instrument,with a normal value < 35 KU/L.BNP was detected by Triage MeterPro fluorescence immunoassay,with a normal value < 100 pg/L.Cardiac function was assessed within 1 week after coronary artery perfusion.The correlation between serum CA125,BNP and cardiac color ultrasound was analyzed.Echocardiography was detected by Hitachi Preirus ultrasonic diagnostic instrument.To detect and record into the group of patients with LVEF,left ventricular end-diastolic diameter,left ventricular end-diastolic diameter,LVEDD),left ventricular end systolic diameter(left ventricular end-systolic diameter,LVESD)and Killip classification.CA125,BNP and left ventricular ejection fraction(LVEF)were compared among different Killip grading groups in HF group.SPSS 18.0 statistical software was used for statistical analysis of the data.Measurement data were expressed as X s,and t test was used to compare the mean of measurement data between the two groups.Counting data were expressed by rate,and independent paired binary data were compared by chi-square test.Pairwise comparison of measurement data between multiple groups of samples was conducted by using one-way ANOVA.Multivariate Logistic regression analysis was performed for risk factors with P < 0.05,and odds ratio(OR)and 95% confidence interval(95% CI)were calculated.Pearson correlation analysis was used for correlation analysis.Receiver operating characteristic curve(ROC)is used to evaluate the sensitivity and specificity of the predicted HF.P < 0.05 was considered statistically significant.Result(1)A total of 124 patients with AMI were enrolled,and 41 patients(33.1%)presented AHF meeting the diagnostic criteria within one week.The incidence of previous diabetes(41.5% vs.24.1%,P=0.047)and myocardial infarction(20.5% vs.4.9%,P=0.023)was significantly higher in the AHF group than in the non-ahf group.The incidence of double-vessel coronary artery disease(22.0% vs.8.4%,P=0.042)and three-vessel coronary artery disease(26.8% vs.3.6%,P=0.035)was significantly higher in the AHF group than in the non-ahf group.Age(72.16 5.32 vs 64.90 7.00 years old,P=0.085)and previous history of hypertension(78.0% vs 63.9%,P=0.08)in the AHF group were higher than those in the non-ahf group,but did not reach statistical significance.(2)In terms of cardiac ultrasound parameters,only LVEF(42.17±4.94 vs 56.46±6.63%)was observed between the two groups,P=0.028 The difference was statistically significant.LVEDD(P=0.423)and LVESD(P=0.878)showed no significant difference.The results of laboratory examination showed that there were statistically significant differences in serum BNP level(582.49±140.09 vs 330.62±102.03ng/L,P = 0.024),CA125(126.42±34.48 vs 79.97±23.84kU/L,P = 0.045)and cTnI(4.14±1.98 vs 3.35±1.41 ug/L,P = 0.014).CRP(P=0.594),UA(P=0.125),BUN(P=0.741),SCr(P=0.547)were not statistically significant.(3)Logistics regression analysis of differentialgeneral clinical indicators of the two groups,such as history of diabetes,history of myocardial infarction,LVEF,BNP,CA125,cTnT,and the number of coronary artery lesionsshowed that the level of CA125(OR=0.922,95%CI 0.869-0.978,P=0.007)and BNP(OR=0.977,95%CI 0.962~0.992,P=0.003),LVEF(OR=1.262,95%CI 1.028-1.549,P=0.026),the number of coronary artery lesions(Two lesions: OR=0.863,95%CI 0.903-1.006,P=0.026,Three lesions:OR = 1.085,95%CI0.875-1.017,P=0.018),while the history of myocardial infarction(P=0.569),history of diabetes(P=0.758)and cTnI(P=0.860)were not different between two groups.(4)Serum CA125 and BNP levels were negatively correlated with LVEF in the two groups(r =-0.227,P = 0.011).There was a positive correlation between CA125 and BNP(r = 0.270,P = 0.002).ROC curve showed that the area under curve(AUC)of serum CA125 level for predicting AHF after AMI was 0.775(95%CI 0.691-0.859,P< 0.01),and the AUC of serum BNP level was 0.814(95%CI 0.736-0.893,P < 0.01).AUC at the combined level was 0.889(95%CI 0.830-0.949,P< 0.01).The serum CA125 level of 128.23kU/L was set as the cut-off to predict the occurrence of subsequent heart failure,while the sensitivity and specificity of AHF diagnosis were 61.2% and 90.8%.While the cut-off of BNP was 128.23kU/L,and the sensitivity and specificitywere 82.0% and 83.6%,respectively.Finally,The sensitivity and specificity of CA125 combined with BNP in the diagnosis of AHF were 83.6% and 85.7% respectively.(5)One-way ANOVA showed that the serum CA125(P<0.05)and BNP(P<0.05)levels increased as the killip grating goes up in the AHF group,and LVEF(P<0.05)levels decreased with the increase of grading,and the differences of CA125,BNP and LVEF between the groups were statistically significant(P< 0.001).Conclusion(1)Serum CA125 level was positively correlated with BNP,while BNP level was negatively correlated with LVEF,and CA125 and BNP levels were negatively correlated with LVEF.It has predictive value for AHF after AMI.(2)Serum CA125 and BNP levels were increased in AHF patients after AMI.Its serum concentration is closely related to the cardiac function of AHF patients.The higher the degree of cardiac function deterioration is,the higher the serum CA125 and BNP concentration is,and the lower the LVEF level is.Therefore,serum CA125 combined with BNP has a good diagnostic and predictive value for the occurrence of AHF after AMI,and serum CA125 and BNP levels are significantly increased with the progression of the disease,which is positively correlated with the severity of acute myocardial infarction complicated with AHF.Serum CA125 and BNP levels can be used as markers reflecting the degree of cardiac function damage in HF patients after AMI,and combined detection of the two can improve the sensitivity of early AHF diagnosis. |
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