Study on the relationship between Plasma Pro amino terminal brain natriuretic peptide, left ventricular mass index and the prognosis in elderly heart failure patients with preserved ejection fraction

Objective To investigate the clinical value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)and Left ventricular mass index(LVMI )in evaluating the prognosis of elderly heart failure patients with preserved ejection fraction (HFpEF). Methods From January 2018 to December 2018, 170 patients with heart failure (age≥65years old) in the Third Affiliated Hospital of Anhui Medical University were selected as the subjects of prospective study.According to the left ventricular ejection fraction (LVEF), the patients were divided into two groups: the heart failure with preserved ejection fraction (HFpEF) group (100 cases), the heart failure with reduced ejection fraction (HFrEF) group (70 cases), and the healthy subjects (58 cases) as the control group.Left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVEDD), LVEF, left ventricular mass index (LVMI) and plasma NT-proBNP concentrations were compared among the three groups.The study group was followed up for 6 months after standardized treatment to observe the occurrence of major cardiovascular adverse events (MACE). Multiple logistic regression was used to analyze the correlation between the above indexes and the occurrence of mace.ROC curve was used to analyze the predictive value of NT proBNP and LVMI. Results There were significant differences in LAD, IVSTt, LVPWT, LVEDD, LVEF and LVMI among each group (F value was 110.878, 75.838, 74.044, 137.985, 495.267 and 122.810, respectively, all P<0.001 ). The LAD, IVST, LVPWT, LVEDD, and LVMI in the HFpEF group((40.81 ±4.46) mm, (9.39±1.15) mm, (9.68±1.11) mm, (55.54±3.67) mm, (125.45±19.17) g/m2) were higher than those in the control group ((32.9±3.20) mm, (7.62±0.64) mm, (7.81±0.58) mm, (47.05±3.13) mm, (77.72±11.79) g/m2), and the LVEF was lower than that of the control group ((59.63±5.23)% vs.(67.7±4.35)%) with statistical significance (all P<0.05). IVST, LVPWT, LVEF in HFpEF group( (9.39±1.15) mm, (9.68±1.11) mm, (9.63±5.23)%) were higher than those in HFrEF group ((7.59±1.28) mm, (8.01±1.39) mm, (36.9±7.63 )%) ; and the LAD, LVEDD in HFpEF group ((40.81±4.46) mm, (55.54±3.67) mm) were lower than those in HFrEF group ((45.51±6.1) mm, (64.77±9.55) mm), and the differences were statistically significant (all P<0.05). The plasma NT-proBNP concentration was the lowest in the control group, followed by the HFpEF group and the highest in the HFrEF group(56.0 (30.0, 78.56), 2 624.5 (1 190.5, 5 558.5), 8 528.5 (2 651.0, 21 582.75), F=81.355, P<0.01). Multivariant Logistic regression analysis showed that NT-proBNP and LVMI were independent risk factors for occurrence of MACE in patients with HFpEF(OR=4.796, 95%CI: 2.348-5.127, P=0.035; OR=1.957, 95%CI: 1.810-3.327, P=0.016). ROC curve analysis showed that the area under the curve of cardiovascular adverse events predicted by NT-proBNP and LVMI for 6 months was 0.888(95%CI: 0.825-0.950, P<0.001) and 0.713(95%CI: 0.613-0.812, P=0.013). Conclusion NT-proBNP and LVMI have important value for prognosis evaluation in elderly patients with HFpEF. Key words: Heart failure; Heart failure with preserved ejection fraction; N-terminal pro-brain natriuretic peptide; Left ventricular mass index; Prognosis