| BackgroundHeart failure is a disorder of systolic and/or diastolic dysfunction of ventricular caused by various cardiac structural and/or functional diseases,which result in a group of clinical syndromes.With the aging of the population in China,the prevalence of heart failure is increasing year by year,and the disease has a high mortality rate and a poor prognosis,so early diagnosis and treatment are particularly important.The main pathological feature of chronic heart failure(CHF)is ventricular remodeling.Traditional biomarkers such as B-type natriuretic peptide(BNP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)have been widely used in the diagnosis and prognosis of heart failure.However,ventricular remodeling is a complex process involving multiple humoral factors.Therefore,we need to find new biomarkers to explore the mechanism of ventricular remodeling in order to provide help for the diagnosis and treatment of heart failure.Studies have shown that vascular endothelial growth factor(VEGF)can induce the formation of new blood vessels under the mediation of hypoxia and inflammation,thereby participating in the pathophysiological process of the occurrence and development of heart failure.Anti-angiogenic factors such as endostatin(ES)and thrombospondin-1(TSP-1)are also involved in the repair process after myocardial injury.These factors interact with each other and affect the occurrence and development of heart failure.But its specific mechanism is still unclear and needs in-depth study.ObjectiveEnzyme-linked immunosorbent assay(ELISA)was used to detect the levels of ES,TSP-1 and VEGF in the serum of CHF patients.Explore the correlation between ES and TSP-1 and CHF,and evaluate their diagnostic value for CHF.MethodsFrom December 2018 to June 2019,119 patients with CHF who were hospitalized in the department of cardiology in our hospital were selected as the heart failure group.According to the classification criteria of Chinese Guidelines for Diagnosis and Treatment of Heart Failure 2018,CHF patients were divided into 3 groups.There are 39 patients in heart failure group with reduced ejection fraction(HFrEF group),25 patients in heart failure group with mid-range ejection fraction(HFmrEF group)and 55 patients in heart failure group with preserved ejection fraction(HFpEF group).Another 39 patients with normal cardiac function who were hospitalized during the same period were included as the control group.Collect the patient's medical history and the results of laboratory test and echocardiography.The serum levels of ES,TSP-1 and VEGF were measured by ELISA method.The correlation of serum levels of ES and TSP-1 with VEGF,NT-proBNP,left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were analyzed,and their diagnostic value for CHF was evaluated.Results1.The prevalence of hypertension in the HFpEF group was higher than that in the control group,and the difference was statistically significant(P<0.05).Compared with the control group,the serum level of NT-proBNP and LVEDD in the HFpEF group,HFmrEF group and HFrEF group were increased with the LVEF decreased.Compared with the HFpEF group,the serum level of NT-proBNP and LVEDD in the HFmrEF group and the HFrEF group were increased with the LVEF decreased.Compared with HFmrEF group,the serum level of NT-proBNP and LVEDD in the HFrEF group were increased with the LVEF decreased.The differences were statistically significant(P<0.05).2.Compared with the control group,the serum levels of ES,TSP-1 and VEGF in HFpEF group,HFmrEF group and HFrEF group were all increased.Compared with HFpEF group,the serum levels of ES and TSP-1 in HFrEF group were increased.Compared with HFmrEF group,the serum levels of ES and TSP-1 in HFrEF group were increased.The differences were statistically significant(P<0.05).3.Correlation analysis results showed that the serum level of ES in patients with heart failure group was positively correlated with VEGF,NT-proBNP and LVEDD,and negatively correlated with LVEF(all P<0.05),but not significantly correlated with TSP-1(P>0.05).The serum level of TSP-1 in patients with heart failure group was positively correlated with NT-proBNP and LVEDD,and negatively correlated with LVEF(all P<0.05),but not significantly correlated with VEGF(P>0.05).4.The ROC working curve showed that,among ES,TSP-1,VEGF and NT-proBNP,in addition to NT-proBNP,ES has the best diagnostic value for CHF,followed by TSP-1.The sensitivity and specificity for the diagnosis of CHF were 0.916 and 0.795 respectively when the ES concentration was 128.69ng/mL,and 0.647 and 0.846 respectively when the TSP-1 concentration was 15.22ng/mL.Conclusion1.Serum ES and TSP-1 participate in the occurrence and development of CHF,and can reflect the severity of CHF.2.The role of ES in CHF may be related to VEGF.3.ES and TSP-1 are new biomarkers for better diagnosis of CHF. |
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