| Objective:To explore the diagnostic value of peripheral blood mitochondrial DNA(mtDNA),growth differentiation factor-15(GDF-15)combined with brain natriuretic peptide(BNP)in patients with heart failure(HF).Methods:A total of 74 patients with heart failure were enrolled in the Department of Cardiology of the Affiliated Hospital of Chengde Medical College as the heart failure group,according to New York Heart Association(NYHA),including 10 patients with NYHA class Ⅱ,14 patients with NYHA class ⅡI and 50 patients with NYHA class IV,and 75 patients with normal cardiac function in the same period served as the control group.During this period,All the subjects signed the informed consent form,and this study has been approved by the hospital ethics review committee.The general clinical data such as blood pressure and heart rate,routine biochemical indexes such as liver function,renal function,blood lipids,ions,blood routine and echocardiography were recorded.The peripheral blood samples were collected.The content of mtDNA in peripheral blood was detected by real-time quantitative RT-PCR.The content of GDF-15 in serum was measured by ELISA.The content of BNP was detected by electrochemiluminescence.To analyze the diagnostic value of combined mtDNA,GDF-15 and BNP in patients with heart failure.Results:1.Comparison of general clinical data between the two groups:compared with the control group,the heart failure group had more males,more older,lower Systolic Blood Pressure(SBP)and faster Heart Rate(HR),and the differences were statistically significant(P < 0.05).2.Comparison of laboratory indexes,BNP,mtDNA and GDF-15:compared with the control group,the Red blood cell Distribution Width(RDW),monocyte ratio,Total Bilirubin(TBIL),Glutamic Oxaloacetic Yransaminase(AST),Creatinine(Cr),Uric Acid(UA),Blood Urea Nitrogen(BUN),BNP and GDF-15 were higher in the heart failure group,and the differences were statistically significant(P < 0.05).Red Blood Cell(RBC),platelet(PLT),Total Protein(TP),Total Cholesterol(TC),Triglyceride(TG),Low Density Lipoprotein Cholesterol(LDL-C),High Density Lipoprotein Cholesterol(HDL-C),mtDNA were lower,the difference was statistically significant(P < 0.05).3.Comparison of echocardiographic indexes: compared with the control group,the Left Ventricular Ejection Fraction(LVEF)was lower,the Left Atrium(LA)was greater,the Left Ventricular End-Systolic anteroposterior Diameter(LVSDD)and the Left Ventricular End-Diastolic anteroposterior Diameter(LVEDD)were greater in the heart failure group,the difference was statistically significant(P < 0.05).4.Comparison of the levels of peripheral blood mtDNA,GDF-15 and BNP in the control group and the NYHA group: the serum levels of GDF-15 and BNP in patients with NYHA class Ⅱ were higher than those in the control group,and the mtDNA,GDF-15 and BNP in patients with NYHA class ⅡI were significantly higher than those in the control group(P < 0.05).Compared with the control group,the levels of mtDNA,GDF-15 and BNP in patients with NYHA class IV were higher,and the difference was statistically significant(P < 0.05).Comparison of mtDNA,GDF-15 and BNP levels in HF patients with different NYHA: BNP levels in patients with NYHA class ⅡI were significantly higher than those in patients with NYHA class Ⅱ,and mtDNA,GDF-15 and BNP levels in peripheral blood of patients with NYHA class IV were significantly higher than those in patients with NYHA class Ⅱ(P < 0.05).NYHA ⅡI is compared with NYHA IV levels,each indicator has no statistical differences.NYHA ⅡI is compared with NYHA IV levels,each indicator has no statistical differences.5.Univariate regression analysis showed that the heart failure group more than older the control group,the atrial fibrillation rate was higher,the total bilirubin,creatinine,uric acid,urea nitrogen,BNP,GDF-15 increase,left ventricular shrinkage Large,left ventricular diastolication before and after the late back path;the platelet count,left ventricular ejection fraction,and the peripheral blood mtDNA content decreased.In the multi-factor regression analysis model of gender,age,whether or not the atrial fibrillation,the increase in GDF-15 level is shown,and the decrease in the peripheral blood mtDNA content is an independent risk factor of heart failure.6.In linear correlation analysis,GDF-15 was positively correlated with age(r = 0.446,P < 0.001),LVEDD(r = 0.270,P = 0.001),BNP(r = 0.392,P< 0.001),and negatively correlated with LVEF(r =-0.319,P < 0.001),mtDNA(r =-0.459,P < 0.001).mtDNA was positively correlated with LVEF(r = 0.303,P < 0.001),and negatively correlated with age(r =-0.651,P <0.001),BNP(r =-0.422,P < 0.001),LVEDD(r =-0.257,P = 0.002)and GDF-15(r =-0.459,P < 0.001).7.Compared with the control group,the mtDNA in peripheral blood was lower,and the level of GDF-15 and BNP was higher in HF group,the difference was statistically significant(P<0.05).Receiver Operating Characteristic Curve(ROC)analysis showed that the area under the curve of BNP in patients with HF was 0.964(95%CI:0.938-0.990),the sensitivity was93.2%,and the specificity was 89.3%.The area under the curve of patients with heart failure diagnosed by GDF-15 was 0.803(95%CI:0.734-0.872),the sensitivity was 85.1%,and the specificity was 66.7%,the optimal cut-off value is 1591.4pg/ml.The area under the curve of patients with heart failure diagnosed by mtDNA was 0.784(95%CI:0.712-0.857),the sensitivity was57.3%,and the specificity was 94.6%,the optimal cut-off value is 1.228.The area under the curve of BNP combined with GDF-15 diagnosis of heart failure was 0.964(95%CI:0.938-0.989),the sensitivity was 83.8%,and the specificity was 98.7%.The area under the curve of BNP combined with mtDNA diagnosis of heart failure was 0.974(95%CI:0.954-0.995),the sensitivity was 93.2%,and the specificity was 99.2%.The area under the curve of the combination of the three factors of patients with heart failure was 0.979(95%CI:0.959-0.998),the sensitivity was 91.9%,and the specificity was 94.7%.Conclusion:The expression of mtDNA in peripheral blood of patients with HF patients decreased,while the levels of GDF-15 and BNP increased,among which BNP was the most effective in the diagnosis of heart failure.Combined with mtDNA and GDF-15 could improve the diagnostic ability of heart failure. |
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