Objective To analyze the predictive value of serum 8-hydroxy Deoxyguanosine(8-OHdG) combined with dynamic arterial stiffness index(AASI) for major adverse cardiovascular events(MACE) in patients with hypertension and chronic heart failure. Methods One hundred and thirty-two patients with hypertension and chronic heart failure who were diagnosed and treated in Cardiovascular Department of the Second Affiliated Hospital of Wannan Medical College from January 2019 to January 2022 were selected. According to whether MACE occurred within one year after discharge, they were divided into MACE group and non-MACE group(NMACE group). Compare the differences in clinical data, serum 8-OHdG, and AASI between two groups of patients; Multivariate logistic regression analysis of risk factors for MACE in patients with hypertension and chronic heart failure; The diagnostic value of receiver operating characteristic curve(ROC) analysis of serum 8-OHdG and AASI in patients with hypertension and chronic heart failure complicated with MACE. Results Following up for one year, the incidence of MACE in patients with hypertension and chronic heart failure was 31.82%(42/132). MACE group patients' 8-OHdG, AASI, NYHA cardiac function grading, tumor necrosis factor-α(TNF-α), the brachial ankle artery pulse conduction velocity(ba PWV) were significantly higher than that of the NMACE group, while the left ventricular Ejection fraction(LVEF) was significantly lower than that of the NMACE group [t(χ2)/P=16.881/<0.001, 12.437/<0.001, 8.921/0.030, 7.234/<0.001, 9.492/<0.001, 6.095/<0.001]; Logistic multivariate regression analysis showed that high serum 8-OHdG and AASI were both risk factors for MACE in patients with hypertension and chronic heart failure [OR(95% CI)=2.447(1.809-3.309), 1.853(1.471-2336)]; The analysis of Receiver operating characteristic showed that the area under the Receiver operating characteristic(AUC) predicted by serum 8-OHdG, AASI and their combination for hypertension patients with chronic heart failure complicated with MACE were 0.756, 0.712 and 0.867, respectively. The AUC predicted by both was higher than the single index(Z/P=2.969/0.031, 3.558/0.015). Conclusion Patients with hypertension and chronic heart failure complicated by MACE have significantly elevated serum 8-OHdG and AASI, which are independent risk factors for hypertension and chronic heart failure complicated by MACE. Combined detection of the two can improve the diagnostic efficacy of patients with MACE.
Objective To explore the relationship between serum cluster protein(Clusterin), tissue kallikrein 1(KLK1), and the condition of elderly acute heart failure(AHF), as well as the evaluation value of their prognosis. Methods From July 2019 to October 2021, 80 elderly patients with AHF who were admitted to the Fourth Department of Cardiovascular Internal Medicine of the Second Hospital of Hebei Medical University were selected as the study subjects(AHF group), and 80 patients who underwent physical examination in the hospital during the same period were selected as the healthy control group. AHF patients were divided into mild subgroups(n=37) and severe subgroups(n=43) based on cardiac function, and into endpoint subgroups(n=36) and non-endpoint subgroups(n=44) based on whether the patient experienced endpoint events. Compare the basic information and serum Clusterin and KLK1 levels between each group; Spearman correlation analysis of the relationship between serum Clusterin, KLK1 levels and severity of AHF patients; Logistic regression analysis of the influencing factors of endpoint events in AHF patients; The evaluation value of serum Clusterin and KLK1 levels in predicting the prognosis of AHF patients using receiver operating characteristic curve(ROC) analysis. Results The levels of SCr, TnI, CK-MB, NT proBNP, LVEDD, BNP, and Clusterin in the AHF group were significantly higher than those in the healthy control group(t/P=8.439/<0.001, 31.607/<0.001, 5.212/<0.001, 15.676/<0.001, 11.106/<0.001, 17.847/<0.001, 12.792/<0.001), while the levels of LVEF and KLK1 were significantly lower than those in the healthy control group(t/P=3.900/<0.001, 8.963/<0.001); The levels of TnI, CK-MB, NT proBNP, BNP, and Clusterin in the endpoint event subgroup were significantly higher than those in the non endpoint event subgroup(t/P=8.389/<0.001, 3.517/0.001, 10.993/<0.001, 5.626/<0.001, 7.303/<0.001), while the levels of LVEF and KLK1 were significantly lower than those in the non endpoint event subgroup(t/P=2.749/0.007, 6.225/<0.001); Compared with the mild subgroup patients, the severe subgroup patients showed a significant increase in serum Clusterin levels and a significant decrease in KLK1 levels(t/P=8.236/<0.001, 12.703/<0.001); The Spearman correlation analysis results showed that the serum Clusterin level of AHF patients was significantly positively correlated with the severity of the disease(r=0.613, P<0.01), while the serum KLK1 level was significantly negatively correlated with the severity of the disease(r=-0.680, P<0.01); The results of logistic regression analysis showed that high BNP, high Clusterin, and low KLK1 were risk factors affecting the progression of AHF patients to adverse end points [OR(95% CI)=1.401(1.132-1.735), 1.545(1.219-1.959), 1.624(1.246-2.116)]; The results of Receiver operating characteristic showed that the area under the curve(AUC) of serum Clusterin, KLK1 and their combined assessment of AHF patients' prognosis were 0.879, 0.834 and 0.964, respectively. The AUC of their combined assessment of AHF patients' prognosis was greater than the single prediction(Z/P=0.001/0.045, 2.712/0.007). Conclusion Serum Clusterin and KLK1 have good evaluation value for the condition and prognosis of elderly AHF
Objective To analyze the relationship between the expression of long chain non coding RNA H19(LncRNA H19) and microRNA-214(miR-214) in plasma extracellular vesicles of patients with chronic heart failure(CHF), inflammatory factors, and left ventricular remodeling. Methods From July 2020 to September 2022, 120 CHF patients were selected as the CHF group, and 40 healthy volunteers were selected as the healthy control group. The expression of LncRNA H19 and miR-214 in plasma exosomes was detected by real-time fluorescence quantitative Polymerase chain reaction, and the inflammatory factor [interleukin(IL)-1 was detected by enzyme-linked immunosorbent assay β, IL-6, IL-18, Tumor Necrosis Factor-α(TNF-α)] Horizontal, echocardiographic detection of left ventricular remodeling indicators [left ventricular end diastolic diameter(LVEDD), left ventricular posterior wall thickness(LVPWT), end diastolic interventricular septal thickness(IVST), and left ventricular myocardial mass index(LVMI)]. Predict the relationship between LncRNA H19 and miR-214 through the StarBase database. Pearson/Spearman correlation analysis was used to investigate the correlation between the expression of plasma exosomes LncRNA H19 and miR-214 in CHF patients and the New York Heart Association(NYHA) cardiac function grading, inflammatory factors, and left ventricular remodeling indicators. Draw the receiver operating characteristic curve(ROC) to obtain the efficacy of plasma extracellular vesicles LncRNA H19 and miR-214 in predicting left ventricular remodeling in CHF patients. Results Compared with the healthy control group, the CHF group showed plasma exosomes LncRNA H19 expression and serum IL-1 β, IL-6, IL-18, TNF-α, and LVEDD, LVPWT, IVST, and LVMI increased, while the expression of miR-214 decreased(t=15.837, 93.717, 86.669, 103.761, 76.500, 9.953, 29.647, 30.652, 13.832, 11.256, all P<0.001). The expression of plasma extracellular LncRNA H19 and serum IL-1 in patients with NYHA grade II, III, and IV CHF β, IL-6, IL-18, TNF-α, the levels of LVEDD, LVPWT, IVST, and LVMI increased sequentially, while the expression of miR-214 decreased sequentially(F=247.164, 182.669, 259.385, 298.349, 235.816, 196.860, 171.320, 182.099, 179.760, 138.863, all P<0.001). According to the StarBase database prediction, there is a complementary sequence between LncRNA H19 and miR-214. Pearson/Spearman correlation analysis showed that plasma exosomes LncRNA H19 and IL-1 in CHF patients β, IL-6, IL-18, TNF-α, NYHA cardiac function grading, LVEDD, LVPWT, IVST, LVMI were positively correlated, but negatively correlated with miR-214(r=0.739, 0.774, 0.789, 0.767, 0.899, 0.753, 0.735, 0.743, 0.752,-0.885, P<0.001); miR-214 and IL-1 β, IL-6, IL-18, TNF-α, NYHA cardiac function grading, LVEDD, LVPWT, IVST, and LVMI were negatively correlated(r=-0.785,-0.783,-0.779,-0.773,-0.839,-0.761,-0.767,-0.745,-0.751,-0.885, all P<0.001). The area under the curve(AUC) of plasma extracellular vesicles LncRNA H19, miR-214, and binomial combination for predicting left ventricular remodeling were 0.780, 0.779, and 0.877, respectively. The AUC of binomial combination was higher than that of single prediction(Z=3.026, 3.114, P=0.003, 0.002). Conclusion The high expression of LncRNA H19 and low expression of miR-214 in plasma exosomes of CHF patients are closely related to inflammatory response and left ventricular remodeling, and may become an evaluation index for the severity of CHF patients' condition and left ventricular remodeling.
Objective To observe the effect of different hypoglycemic strategies in patients with type 2 diabetes(T2DM) and heart failure with preserved ejection fraction(HFpEF).Method A total of 60 patients with T2DM and HFpEF diagnosed and treated in the General Medicine Department of Mianyang Hospital/Mianyang Central Hospital Affiliated to the School of Medicine of Electronic Science and Technology University from January 2020 to January 2022 were collected. They were randomly divided into a control group, a daggliflozin group, and a dulaglutide group using a random number table method, with 20 patients in each group. The control group received regular basic treatment, and the daggliflozin group and dulaglutide group received corresponding drugs on this basis. After 6 months of treatment, observe the changes in fasting blood glucose(FPG), 2-hour postprandial blood glucose(2hPG), glycated hemoglobin(HbA 1c), body mass, N-terminal proBNP precursor, left ventricular end diastolic diameter(LVEDD), left atrial diameter(LAD), systolic blood pressure(SBP), diastolic blood pressure(DBP), alkaline phosphatase(ALP), serum bone specific alkaline phosphatase(BAP), osteoprotegerin(OPG), and body mass of the patients; Compare the incidence of clinical adverse reactions among three groups of patients.Results After treatment, FPG, 2hPG, and HbA 1c in all three groups of patients decreased compared to before treatment(control group: t/P=1.863/0.026, 3.485/<0.001, 1.711/0.033; daggliflozin group: t/P=2.088/0.003, 5.255/<0.001, 2.211/0.001; dulaglutide group: t/P=3.003/<0.001, 6.931/<0.001, 4.678/<0.001), and="" the="" decrease="" in="" dulaglutide="" group="" was="" greater="" than="" that="" daggliflozin="">control group(F/P=8.881/0.001, 9.228/0.001, 11.170/<0.001); After treatment, SBP, DBP, NT ProBNP, LVEDD, and LAD were all reduced in three groups of patients(control group: t/P=1.801/0.027, 3.079/0.001, 9.719/0.001, 1.522/0.045, 3.291/0.001, dapagliptin group: t/P=1.884/0.025, 4.256/<0.001, 11.216/<0.001, 4.109/<0.001, 4.297/<0.001, dulaglutide group: t/P=1.903/0.025, 4.331/<0.001, 12.377/<0.001, 4.176/<0.001, 4.558/<0.001), and NT ProBNP The improvement amplitude of LVEDD and LAD was greater in the Laxitopeptide group than in the Daggliflozin group than in the control group(F/P=0.251/0.780, 0.400/0.675, 15.500/<0.001, 7.631/0.002, 9.601/0.001).; After treatment, the ALP, BAP, OPG levels in the Dulaglutide group and control group increased(control group: t/P=1.997/0.046, 2.123/0.002, 2.019/0.040, Dulaglutide group: t/P=3.669/0.001, 4.223/<0.001, 5.995/<0.001), while="" the="" changes="" in="" bone="" metabolism="" indicators="" dulaglutide="" group="" were="" not="" p="">0.05), and the improvement in the Dulaglutide group was greater than that in the control group>Dulaglutide group(F/P=6.372/0.005, 10.877/<0.001, after="" there="" was="" no="" significant="" improvement="" in="" the="" body="" mass="" of="" patients="" control="" p="">0.05), but there was a significant decrease in patients in the dulaglutide and daggliflozin groups(t/P=2.129/0.002, 1.466/0.049), and the decrease in the dulaglutide group was greater than that in the daggliflozin group(t/P=6.677/0.008). There was no statistically significant difference in adverse reactions among the three groups after treatment(P>0.05).Conclusion The application of Dulaglutide in patients with T2DM combined with HFpEF not only improves clinical efficacy, but also reduces the incidence of clinical adverse reactions.