| [Objective]:Heart failure(Heart Failure,HF for short)is currently the world’s leading cause of death,and ischemic cardiomyopathy accounts for about 50%of them.Despite the continuous emergence of various treatment techniques for heart failure,it still cannot curb its high morbidity and mortality.Therefore,the disease characteristics and treatment status of patients with cardiac dysfunction caused by myocardial infarction are identified,and new causes of ventricular remodeling The deteriorating mechanism and the search for new effective treatments for patients with heart failure caused by ischemic cardiomyopathy are urgent problems that need to be solved.[Methods]:The Patients who were admitted to the Cardiovascular Diseases Hospital of Xiamen University from April 2019 to November 2019 and were diagnosed with ischemic cardiomyopathy through cardiac color Doppler ultrasound were included.Patients with normal coronary angiography during the same period and no cardiac color Doppler structure were included.And those with abnormal functions were the control group.According to the cardiac ventricular ultrasound left ventricular ejection fraction,it was divided into the following four groups:LVEF≥50%group,41%≤LVEF≤49%group,LVEF≤40%group,and control(CON)group.The clinical data,biochemical data,inflammation indicators and brain natriuretic peptide levels of the study subjects were collected.Three days after admission,venous blood was collected,and serum was separated for ELISA to detect the levels of CD163 and TWEAK.Mononuclear macrophages were isolated from venous blood and protein was extracted.Western blot was used to detect the protein levels of TWEAK and NF-κB downstream of CD 163.[Results]:(1)There were no differences in age,gender,blood pressure,and BMI among the groups;in the LVEF≥50%group,41%≤LVEF≤49%group,and LVEF≤40%group,the smoking rates were 68.75%,85.71%,and 50,respectively.%,At least half of patients with coronary heart disease are still smoking.In the LVEF≤40%group,the incidence of diabetes was 50%,which was significantly higher than other groups;compared with the LVEF≥50%group,the heart rate was significantly higher in the 41%≤LVEF≤49%group and the LVEF,40%group;41%In the≤LVEF≤49%group and LVEF≤40%group,86%and 93.3%of the myocardial infarction years were longer than 1 year,respectively,and the proportion of the three vascular lesions was 60%and 56.7%,which were significantly higher than the LVEF≥50%group.(2)The levels of hs-cTNT(101.6±152.3 pg/ml and 84.97±103.6 pg/ml in the 41%≤LVEF≤49%group and LVEF≤40%group were significantly higher than those in the control group and LVEF≥50%group(13.55±18.58 pg/ml and 34.46 ± 55.71 pg/ml);compared with each group,the endogenous creatinine clearance and estimated glomerular filtration rate of patients in the LVEF(40%group were significantly reduced(P<0.01)).(3)NT-proBNP levels,LVD,and LVS were significantly higher in the LVEF≤40%group than in the other groups(P<0.05),and increased more significantly with the decrease in ejection fraction;compared with the CON group and LVEF≥50%Compared with the group,the index of diastolic dysfunction E/e’ increased significantly in the 41%≤LVEF≤49%group and the LVEF<40%group,which were 14.51 and 19.29,respectively,both greater than 14.(4)Compared with patients in the LVEF≥50%group,41%≤LVEF≤49%group and LVEF ≤40%group took antiplatelet drugs and statins;the use rate of RASS/ARNI was LVEF ≥ 50%Group,41%≤ LVEF ≤ 49%group,LVEF ≤ 40%group were 63.33%,60%,51.62%,with an average of 58%;at least 42%of patients did not use RASS,and ARNI was in the LVEFc40%group.The rate of use in patients with heart failure was 35%,and the rate of beta blockers was 22%,53.33%,and 74.19%,with an average of 50%.(5)Compared with the control group(62.9%),the neutrophil ratio(68.27%)in the LVEF≥50%group has an increasing trend;the 41%≤LVEF≤49%group(71.82%)and the LVEF≤40%group(72.18%)patients were significantly higher;compared with the control group,high-sensitivity C-reactive protein,procalcitonin,blood cell sedimentation rate,and homocysteine levels were significantly increased in LVEF ≤ 40%.(6)Compared with the CON group and LVEF≥50%group,the sCD163 level in the 41%≤LVEF≤49%group increased significantly(P<0.05);while in the LVEF≤40%group,the level of sCD163 decreased to the lowest level,and It was significantly lower than the CON group and the 41%≤LVEF≤49%group(P<0.05).Contrary to the expression level of sCD163,the level of TWEAK gradually increased with the decrease of ejection fraction,and reached the highest in the LVEF≤40%group,which was significantly higher than the CON group and LVEF≥50%group(P<0.05).(7)Western Blot results showed that pNF-κB levels were significantly higher in patients with different degrees of heart failure than in the CON group,and that pNF-κB expression was highest in the LVEF≤40%group;unlike the previous assumption,There were no significant differences in TWEAK levels among the groups.[Conclusion]:Diabetes mellitus and chronic renal insufficiency are important risk factors of ventricular remodeling.The age of myocardial infarction and three vessel coronary lesions are important reasons for the deterioration of cardiac function.In addition to systolic dysfunction,diastolic dysfunction was also found in patients with decreased median and ejection fraction.Persistent inflammatory damage may be an important cause of the deterioration of ventricular remodeling,and CD 163/Tweak/NF-κB may be involved. |
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