The clinical significance on the combined determination of NT-proBNP, H-FABP and cTnI in elder patients with severe heart failure

doi:10.3969/j.issn.1673-8640.2014.04.003

Abstract

Abstract:

Objective　To study the clinical significance on the combined determination of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein(H-FABP)and cardiac troponin I(cTnI)in elder patients with severe heart failure (HF). Methods　The serum NT-proBNP, H-FABP and cTnI levels were determined in 312 elder patients with severe HF ｛main adverse cardiovascular event (MACE)group(194 cases)[cardiogenic readmission group(110 cases) and death group(84 cases)]and no-MACE group(118 cases)｝on admission, day 7, 15, 30 and 60 after treatment, 76 elder patients with no-severe HF and 40 elder healthy subjects. The MACE were followed and observed for 180 d. The significance of NT-proBNP, H-FABP and cTnI for the diagnosis of severe HF and the prediction of death risk was analyzed by receiver operating characteristic(ROC)curve. Survival analysis was performed by Kaplan-Meier curve. Results　The serum NT-proBNP, H-FABP and cTnI levels in elder patients with severe HF were significantly higher than those in elder patients with no-severe HF and healthy subjects (P<0.01), the positive rate of H-FABP in elder patients with no-severe HF was 47.1％, and the positive rate of cTnI was 4.5％. The serum NT-proBNP levels were positively correlated with the grade of New York Heart Association (NYHA)Ⅰ-Ⅳ (r=0.77,P<0.01). The ROC curve indicated that the optimal cut-off values of serum NT-proBNP,H-FABP and cTnI levels for diagnosis in elder patients with severe HF were 4 601.50 ng/L, 5.16 ng/L and 0.025 ng/mL, and the optimal cut-off values of serum NT-proBNP,H-FABP and cTnI levels for the death risk evaluation in elder patients with severe HF were 8 178.50 ng/L, 11.77ng/L and 0.038ng/mL, respectively. The sensitivity of the combined determination was obviously better than those of the individual determinations (P<0.05). Before the treatment, the serum NT-proBNP levels in MACE group were significantly higher than those in no-MACE group(P<0.05), the serum H-FABP levels in death group were significantly higher than those in no-death group(P<0.05), and the serum cTnI levels in various prognosis groups had no statistical significance (P>0.05). The serum NT-proBNP, H-FABP and cTnI levels in no-MACE group on day 7 after treatment were significantly lower than those before the treatment (P<0.05). The decreasing rates of the 3 parameters were >50%, and the serum H-FABP level was lower than the normal reference value. The serum NT-proBNP, H-FABP and cTnI levels in the cardiogenic readmission group on day 15 after treatment were significantly lower than those before treatment(P<0.05), but the decreasing rates of the 3 parameters were <30%,and the serum H-FABP level was higher than the normal reference value. The serum NT-proBNP, H-FABP and cTnI levels in death group on day 7 and day 30 after treatment were significantly higher than those before treatment(P<0.05), and the serum cTnI levels were higher than the normal reference value. Kaplan-Meier survival curve showed that the survival rates of serum NT-proBNP, H-FABP and cTnI levels had significant difference(P<0.05). Conclusions　There is an important clinical significance of the combined determination of serum NT-proBNP, H-FABP and cTnI levels for the diagnosis, prognosis, death risk evaluation and curative effect survey in elder patients with severe HF.

Key words: N-terminal pro-B-type natriuretic peptide, Heart-type fatty acid-binding protein, Troponin I, Heart failure

CLC Number:

R446.1

WU Shuzhi，DENG Sheng，QIN Weiguo，CHEN Jian，YI Bin.. The clinical significance on the combined determination of NT-proBNP, H-FABP and cTnI in elder patients with severe heart failure[J]. , 2014, 29(4): 312-318.

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