ABSTRACT
ObjectiveTo investigate the effect of the levels of serum lipid on the prognosis of patients with severe heart failure.MethodsThe clinical data of 149 patients with severe heart failure was analyzed retrospectively,the levels of serun lipid were compared among different causes and different NYHA cardiac functional grading patients.And the prognosis was compared between low-serum lipid and non-low-serum lipid patients.Results There were significant differences in the levels of total cholesterol(TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),albumin (ALB) among different NYHA cardiac functional grading (P ＜0.05),but there was no significant difference in triacylglycerol (TG) among different NYHA cardiac functional grading(P ＞ 0.05 ).The levels of TC,HDL-C,LDL-C in dilated cardiomyopathy and rheumatic heart disease were lower than those in coronary heart disease combined with hypertension and ischemic cardiomyopathy,there were significant differences (P ＜0.05).Followed up for 2 years,the mortality,deteriorated frequency,hospitalization frequency more than 2 times a year and hospitalization time more than 1 month in low-serum lipid patients [29.0％ (9/31 ),25.8％ ( 8/31 ),48.4％ ( 15/31 ),61.3％ ( 19/31)]were higher than those in non-low-serum lipid patients [9.3 ％ ( 11/118 ),9.3％ ( 11/118 ),17.8％ (21/118 ),24.6％ (29/118 )],and there were significant differences (P ＜ 0.01 or ＜0.05).Conclusions For patients with severe heart failure,NYHA cardiac functional grading has significantly negative correlation with their serum lipid levels.Lower serum lipid levels will seriously affect the prognosis of patients.
ABSTRACT
Objective To investigate the cut-off value of N-terminal portion of pro-brain nairiuretic peptid (NT-proBNP)for detecting various degrees of heart failure(HF)at different ages.Method Totally 48 patients with cardiac dysfunction(NYHA Ⅰ-Ⅳ)were from Department of Emergency Nedicine of Zhongshan Hospital Fudan University.The inclusion criteria inclued:organic heart disease,cardiac dysfunction(NYHA Ⅰ-Ⅳ).The exclusion criteria included:acute coronary syndrome,continuous atrial fibrillation,pulmonary emphysema,lung embolism,chronic renal insufficiency,anaemia,abnormal function of glandula thyreoidea,and tumor.The NT- proBNP was studied in order to find out the relevance of NT-proBNP to the classification of HF among patients aged over75 years old(age≥75 years)and patients aged below 75 years old(age＜75 years).Moreover,the NT- proBNP values were used to differentiate acute cardiogenic dyspnea.The data were expressed as(x±s)and ana- lyzed using analysis of variance and Student's t test with SPSS 11.0.A P value less than 0.05 indicated statistical significance.Results The analysis of NT-proBNP levels showed the leveis of it were associated with the grades of cardiac function and left ventricular ejection fraction(LVEF).NT-proBNP levels in patients aged over 75 years were higher than those in patients aged below 75 years.When patients wele of NYI-IA Ⅱ grade and NYHA Ⅳ grade,the levels of NT-proBNP showed signitieant differences between two sorts of patients(407±277 vs.1358± 967 P＜0.05;3727±1342 vs.9031±2363,P＜0.01).The cut-off value of NT-proBNP determined in 48 patients was at 525 pg/ml(AUC=0.958,sensitivity 100%,specificity 76%),at 1911 pg/ml(sensitivity 73%, specificity 96%)in patients with NYHA Ⅱgrade,which were used to identify severe symptomatic heart failure.The cut-off value of NT-proBNP determined in patients aged over 75 yeats was 849pg/ml(AUC=0.922,sensitivity 100%,s pecificity 57%),at 2990 pg/ml(semitivity 81%,specificity 100%)in patients with NYHA Ⅳ grade.Cobckysions NT-proBNP levels are associated with grades of cardiac functions limit of 75 years.It suggests that higher NT-proBNP value in patients aged over 75 years should be considered to evaluate caidiac function and identify acute cardiac dyspnea.