Study On The Correlation Between Hypoxia Induced Factor 1 And Acute Decompensation Of Chronic Heart Failure

Objective: N-terminal B-type natriuretic peptide(NT-proBNP)is one of the biomarkers widely used in clinical diagnosis of heart failure,but it is still puzzled by the lack of specificity.Therefore,it is necessary to find new diagnostic markers.The purpose of this study was to explore the possibility of predicting the outcome of acute decompensation of chronic heart failure by hypoxia-inducible factor-1a(HIF-1a),and to compare the diagnostic value of HIF-1a and NT-proBNP in chronic heart failure.Methods: Thirty-two patients with acute decompensated chronic heart failure(decompensated group)and 30 patients with stable chronic heart failure(stable group)were enrolled in the study.Twenty normal subjects were recruited as control group.Changes of peripheral blood HIF-1a,NT-proBNP,serum creatinine,hemoglobin concentration,left ventricular ejection fraction(LVEF)and pulmonary edema were detected by enzyme-linked immunosorbent assay(ELISA)before and after treatment in decompensated patients with acute decompensated chronic heart failure at stable stage and in stable group.Condition and acute physiology and chronic health score(APACHE II score).Spearman correlation analysis was used to investigate the changes of HIF-1a in patients with acute decompensation of chronic heart failure(CHF)before treatment and 3 months after treatment,and the correlation between HIF-1a and clinical indicators.By drawing ROC curve and establishing binary logistic regression model to analyze the diagnostic value of HIF-1a chronic heart failure in acute decompensation period,the best diagnostic cut-off value was found.Results: Before treatment,the levels of NT-proBNP and HIF-1a in acute decompensated patients with chronic heart failure were significantly higher than those in stable patients with chronic heart failure and healthy subjects.The levels of NT-proBNP and HIF-1a in stable chronic heart failure patients were significantly higher than those in healthy subjects.At the follow-up of 3 months after treatment,the levels of NT-proBNP and HIF-1a in patients with acute decompensation of chronic heart failure at stable stage were significantly lower than those before treatment.Spearman correlation analysis was performed on the difference between HIF-1a and NT-proBNP before and after treatment in decompensated patients.The results showed that there was a correlation between HIF-1a and NT-proBNP in acute decompensated patients with chronic heart failure(r = 0.52,P < 0.05).The correlation between the levels of HIF-1a and clinical indexes was analyzed before and after treatment in decompensated group and stable group.The results showed that there was no correlation between the levels of HIF-1a and NT-proBNP before treatment in acute decompensated patients with chronic heart failure and the levels of serum creatinine,hemoglobin and pulmonary edema(P > 0.05).The status,LVEF,hospitalization days,readmission times within three months and APACHE-II score were correlated(P < 0.05).In patients with stable chronic heart failure,there was no correlation between NT-proBNP level and related indicators(P>0.05).During the follow-up of 3 months after treatment,1 patient died and 2 were lost to follow-up.During the follow-up period,15 patients were re-hospitalized.29 patients reached stable stage after 3 months.By drawing the ROC curve,the area under the curve is 0.744,the 95% confidence interval is 0.629-0.859,and the Jordan index is 0.4296.The truncation value is 9.53.Two classification Logistic regression models were established,and Logistic regression analysis was performed,and OR value was 1.062(P<0.05).Conclusion: Before treatment,the levels of HIF-1a and NT-proBNP in peripheral blood of patients with stable chronic heart failure and patients with acute decompensation of chronic heart failure were higher than those of normal people.After treatment,the levels of HIF-1a and NT-proBNP in patients with chronic heart failure and acute decompensation were decreased,and the levels of NT-proBNP and HIF-1a in patients with chronic heart failure at 3 months follow-up were reduced to the same level as those in patients with chronic heart failure and stable period,and the changes of HIF-1a and NT-proBNP had the same trend.HIF-1a and NT-proBNP were correlated with clinical parameters in patients with chronic heart failure and acute decompensation.These results suggest that HIF-1a and NT-proBNP are consistent in predicting acute decompensation in chronic heart failure,and can be used as one of the auxiliary indexes for predicting the prognosis of acute decompensation in chronic heart failure.