Relationship Between Catestatin And Sympathetic Activity And Cardiac Function In Patients With STEMI

Objectives:To observe the levels of Catestatin(CST),Norepinephrine(NE),N-terminal fragment of pro-brain sodium peptides(NT-proBNP)and Left ventricular ejection fraction(LVEF)in patients with acute ST segment elevation myocardial infarction(STEMI).And to explore the relationship between CST and sympathetic nerve activity and cardiac function in STEMI patients.Then to further infer the prognostic value of CST in patients with acute myocardial infarction.Methods:200 patients with STEMI admitted to the Second Affiliated Hospital of Kunming Medical University from October 2018 to January 2020 were selected as the research objects.Blood samples were collected on the third day after the onset of the disease.Plasma was collected by centrifugation and refrigerated at appropriate temperature.The levels of CST and NE were measured by ELISA within 3 months.The general situation,past history,biochemical indicators and myocardial injury markers of the enrolled personnel were recorded,and LVEF value were obtained by color Doppler echocardiography.According to the degree of heart failure in STEMI patients,they were divided into four groups:Killip Ⅰ group(n=40),Killip Ⅱ Group(n=48),Killip Ⅲ group(n=57),Killip Ⅳ group(n=55).The basic data of different Killip heart function groups were analyzed and compared by appropriate statistical methods,and the differences of CST,NE,SDNN,LVEF and NT-proBNP.According to LVEF phenotype,STEMI patients were divided into three groups:HF with preserved EF(HFpEF)group(n=156),HF with mid-range EF(HFmrEF)group(n=37)and HF with reduced EF(HFrEF)group(n=7).The differences of CST,NE,SDNN and NT-proBNP among different groups were compared.According to the median NT-proBNP of 200 patients,STEMI patients were further divided into NT-proBNP<1184.5pg/ml group and NT-proBNP≥ 1184.5pg/ml group.The differences of CST,NE and SDNN levels between the two groups were compared.The correlation between CST and NE,NT-proBNP levels was analyzed.The ROC curve was used to analyze the diagnostic value of CST and NE on sympathetic activity in STEMI patients,and the diagnostic value of CST and NT-proBNP in STEMI patients with heart failure.Finally,the predictive value of CST in predicting the prognosis of patients with acute myocardial infarction was evaluated.Results:1.There was no significant difference in Gender,Body mass index(BMI),Cardiac Troponin I(cTnI),Total cholesterol(TC),Triglyceride(TG),Low density lipoprotein cholesterol(LDL-C),Diabetes mellitus history and smoking history among patients with different Killip cardiac function grades(P>0.05).There was significant difference between the different groups of Age and Hypertension history(P<0.05).The difference of CST and NE concentration between different Killip heart function groups was statistically significant(P<0.001).From Killip Ⅰ to Killip Ⅳ,the concentrations of CST and NE gradually increased,and the levels of CST and NE in Killip Ⅳ were the highest.There were significant differences in SDNN,NT-proBNP and LVEF between different groups(P<0.05).The overall trend was the lowest LVEF,NT-proBNP concentration increased and SDNN decreased gradually in KillipⅣ patients.2.There was no significant difference between NE and SDNN groups of three LVEF phenotypes(P>0.05).The difference of CST and NT-proBNP was statistically significant(P<0.05),and the CST concentration in HFpEF group was lower than that of HFmrEF and HFrEF.Meanwhile,with the decrease of LVEF,NT-proBNP increased significantly,and the concentration of NT-proBNP was the highest in HFrEF patients.3.The difference of CST,NE and SDNN between NT-proBNP<1184.5pg/ml group and NT-proBNP≥1184.5pg/ml group was statistically significant(P<0.05).When NT-proBNP was greater than 1184.5pg/ml,the concentration of CST and NE was significantly increased,while SDNN index decreased.4.CST was positively correlated with NE in STEMI patients(r=0.866,P<0.001);CST was positively correlated with NT-proBNP(r=0.302,P=0.048).5.ROC curve analysis results show that CST has certain diagnostic value for the heart failure in patients with STEMI during hospitalization.Conclusions:1.There are differences in the levels of CST,NE and SDNN in patients with different Killip cardiac function grades.With the deterioration of cardiac function,the levels of CST and NE gradually increase,and the SDNN index gradually decreases,which indirectly reflects the excessive activation of sympathetic nervous system.2.When LVEF decreased and NT-proBNP increased,the worse the cardiac function was,the higher the CST level was,suggesting that with the increase of sympathetic activity tension and the severity of heart failure in STEMI patients,the secretion of CST increased.3.CST is positively correlated with NE and NT-proBNP,and CST has certain diagnostic value for heart failure in patients with STEMI during hospitalization.4.In conclusion,it can be inferred that CST level has a certain predictive value for the prognosis of STEMI patients.