| Objective To observe the change levels and correlations of serum growth differentiation factor-15(GDF-15)and various indexes of perioperative cardiac function such as B-type natriuretic peptide(BNP),Left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)during the perioperation of OPCAB,and their predictive value for long-term prognosis was analyzed.Methods1?In this study,57 patients who underwent OPCAB in the cardiac surgery department of Tianjin Chest Hospital from December 2014 to February 2015 were enrolled.Collected the case name,gender,age,discharge date,hospitalization date,NYHA classification,body mass index(BMI),hypertention,diabets,hyperlipidemia,smoking,drinking history,myocardial infarction history,heart failure history,previous cardiovascular surgery history,medication history,angina pectoris attack type within 24 hours before operation and other general preoperative conditions.2?Serum GDF-15 was detected by ELISA,Left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)were measured by echocardiography on the day before operation,the first day post operation and the seventh day post operation.Liver and kidney function,blood routine,blood lipid and other indicators were tested in the postoperative morning.The change levels and correlations of GDF-15,BNP,LVEF and LVEDD were analyzed during the perioperation of OPCAB.3?The patients were followed up for 4 years after operation and divided into two groups according to whether major adverse cardiac events(MACE)occurred or not.The gender,age,preoperative complications,perioperative GDF-15,perioperative BNP,perioperative LVEF,postoperative blood lipid,cardiac troponin and other indicators were compared between the two group.For different continuous variables,Receiver operating characteristic curve(ROC)was used to determine the best threshold for MACE occurrence.The best threshold was further grouped.Kaplan-Meier curves were drawn to evaluate the predictive value of MACE occurrence between the two groups.Results1?Pearson correlation analysis showed that serum GDF-15 level was positively correlated with plasma BNP level(r = 0.54,P< 0.01),negatively correlated with LVEF(r =-0.28,P = 0.038),and no correlation with LVEDD(r = 0.23,P= 0.854)on the day before operation.The serum GDF-15 level of postoperative day 1 was positively correlated with plasma BNP level(r = 0.30,P< 0.01),no correlation with LVEF(r =-0.12,P = 0.385)and LVEDD(r = 0.02,P = 0.877).On the post operative day 7,there was a positive correlation between serum GDF-15 level and plasma BNP level(r = 0.28,P = 0.036).There was a negative correlation with LVEF(r =-0.41,P = 0.002)and no correlation with LVEDD(r = 0.06,P = 0.656).2?The levels of GDF-15 in 57 patients were 1196.56±216.63ng/L ?2184.95±349.17ng/L?1262.91±205.78ng/L respectively on the day before operation and postoperative day 1 and day 7.GDF-15 increased significantly on the first day post operation compared with that of the day before operation(P<0.01),and decreased significantly on the seventh day post operation compared with that of the first day post operation(P<0.01),but there was no significant difference compared with the day before operation(P = 0.189).The levels of BNP were 245.278±222.52ng/L?1065.43±396.43ng/L?400.76±195.06ng/L respectively on the day before operation and postoperative day 1 and day 7.BNP increased significantly on the first day post operation compared with that of the day before operation(P<0.01),and decreased significantly on the seventh day post operation compared with that of the first day post operation(P<0.01),and there was higher than the day before operation(P=0.004).The levels of LVEF were(53.72±6.85)%?(48.14±5.86)%?(53.75±6.36)% respectively on the day before operation and postoperative day 1 and day 7.LVEF decreased significantly on the first day post operation compared with that of the day before operation(P<0.01),and increased significantly on the seventh day post operation compared with that of the first day post operation(P<0.01),but there was no significant change compared with the day before operation(P=0.977).3?Postoperative follow up showed that 57 patients had an average follow-up time of 3.61±0.82 years,and a total of 7 cases of non-fatal cardiovascular events and 5 cases of death caused by cardiovascular events,with the folllow up rate of 100%.There were 45 cases in non-MACE group and 12 cases in MACE group.It was found that the two groups had no statisical significance in gender,smoking,hypertention,BMI,GDF-15(the day before operation,the seventh day post operation),BNP(the day before operation,the seventh day post operation),LVEF(the day before operation,the first day post operation and the seventh day post operation),blood lipid postoperative day 1,c Tn T postoperative day 1.However,there were statistical diffenrences in age,diabetes,hyperlipidemia,GDF-15,and BNP of the first day post operation(P<0.05).4?ROC curve shows that when GDF-15 is 2357.96ng/L on the postoperative day 1,it is the best threshold point for dividing MACE,with sensitivity of 91.7%,specificity of 24.4%,and area under ROC curve(AUC)of 0.890(SE=0.045,P=0.000,95% CI:0.801-0.978);The area under ROC curve(AUC)of BNP was 0.636(SE=0.075,P=0.150,95% CI:0.490-0.783)on the postoperative day 1.5?Kaplan-Meier curves were drawn to evaluate the predictive value of long-term MACE occurrence.The results showed that the incidence of MACE in high GDF-15 group is higher than that in low GDF-15 group(P<0.01),suggesting that GDF-15 was higher than 2357.96ng/L on the postoperative day 1,and the incidence of long-term MACE was higher.Conclusions1?GDF-15 is correlated with the severity of cardiac function during perioperation.2?GDF-15,BNP and LVEF all reached the cutoff value on the postoperative day 1,indicating that the heart function was still in a poor period at the moment.3?Kaplan-Meier curves showed that the increase of GDF-15 on the postoperative day 1 was related to poor prognosis of patients.It was the predictor of MACE and had certain predictive value for the long term prognosis. |
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