Relationship Between Serum Adiponectin Level And Cardiac Dysfunction In Patients With Heart Failure

Objective:To determine whether elevated serum Adiponectin(APN)levels are associated with poor prognosis in heart failure(HF)patients.Methods: This case-control study included patients admitted to the Northern Theater Command General Hospital from January 2017 to December 2019.Seventy patients with mild-to-moderate HF(NYHA III-IV)were included based on left ventricular ejection fraction(35%<LVEF<60%)or plasma Brain Natriuretic Peptide(BNP)levels >400 pg/ml,while 113 patients with severe HF(NYHA III-IV)were included based on LVEF ≤35% or plasma BNP levels >400 pg/ml.The control group(n=86)consisted of patients with atrioventricular block and LVEF >60% without HF.Serum APN levels were measured using an ELISA kit.Data were analyzed using SPSS 18.0,with Logistic regression used to determine whether clinical indicators were independent risk factors for HF.ROC curves used to assess the sensitivity and specificity of APN in HF diagnosis.Kaplan-Meier survival curves used to analyze the impact of low and high APN levels on HF survival time,and Cox regression used to determine whether APN was a risk factor for HF readmission and mortality,adjusted for clinical indicators including age,sex,hypertension,diabetes,NT-pro BNP,LVEF,and LDL-L.The population attributable risk percentage(PAR%)was calculated to assess the relationship between APN and HF and poor prognosis.Results: Serum APN levels increased significantly as LVEF decreased.Stepwise logistic regression analysis revealed that LVEF,NT-pro BNP,and APN were independent predictors of HF,with the regression equation being: incidence of HF =1.72-0.27LVEF+0.055 log NT-pro BNP+0.054*log APN.High serum APN levels had moderate diagnostic value for HF,with an AUC of 0.66(95% CI 0.60-0.74)in ROC analysis.Kaplan-Meier survival curve analysis revealed that HF patients with high APN levels had significantly lower survival rates than those with low APN levels(P=0.004).Univariate and multivariate Cox regression analysis and forest plots showed that increasing APN levels were significantly associated with HF readmission,with a hazard ratio(HR)of 1.977(1.318-2.966,P<0.001).After adjusting for clinical indicators including age,sex,hypertension,diabetes,NT-pro BNP,LVEF,and LDL-L,the association remained significant(HR 1.659,95% CI 1.052-2.614,P=0.029).The PAR% was 29.8%,indicating that nearly one-third of HF cases could be attributed to elevated APN levels.Attribution analysis showed that reducing serum adiponectin levels would reduce the proportion of HF readmissions by 79% and HF deaths by70% in the population.Conclusion: A higher level of APN is inversely correlated with the severity of HF,and is an independent predictor of HF as well as the risk factor for readmission and all-cause mortality.