The Prognostic Value of Heart Failure Echocardiography Index,TGF-β1 and BNP in Patients with Left Ventricular Diastolic Heart Failure

CHEN Dengyu; TIAN Xiaorui; LI Bo

doi:10.12102/j.issn.1672-1349.2025.01.020

Abstract：Objective: To investigate the expression of heart failure ultrasound index (HFEI), transforming growth factor beta 1 (TGF-β1), and brain natriuretic peptide (BNP) in patients with different severity levels of diastolic heart failure (DHF) and their predictive value for prognosis. Methods: A total of 311 DHF patients admitted to our hospital from March 2019 to March 2022 were enrolled as the DHF group. According to the New York Heart Association (NYHA) functional classification at admission, they were divided into the NYHA class II group (91 cases), NYHA class III group (122 cases), and NYHA class IV group (98 cases). Based on whether major adverse cardiovascular events (MACE) occurred within 1 year of follow-up, they were further divided into the MACE group (82 cases) and non-MACE group (229 cases). Another 300 healthy individuals who underwent physical examination during the same period were selected as the control group. The ultrasound and serum data of each group were compared. After adjusting for confounding variables using the COX proportional hazards model, the association between HFEI score, TGF-β1, and BNP with the prognosis of DHF was analyzed. The interaction among HFEI score, TGF-β1, and BNP was evaluated by COX regression. A prognostic model was established using R software, and Bootstrap sampling was used for validation. The discrimination and accuracy of the model were evaluated by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration curve. Results: The LVEDD, LAD, cTnT, Lp(a), TGF-β1, HFEI score, and BNP levels in the DHF group were higher than those in the control group. In the MACE group, TGF-β1, HFEI score, and BNP were higher than in the non-MACE group. TGF-β1, HFEI score, and BNP were positively correlated with NYHA functional classification (P < 0.05). COX regression showed that after adjustment, HFEI score [HR = 2.01, 95% CI (1.78, 2.32), P < 0.001], TGF-β1 [HR = 1.79, 95% CI (1.56, 2.10), P < 0.001], and BNP [HR = 2.13, 95% CI (1.86, 2.41), P < 0.001] were all risk factors for MACE. As the HFEI score, TGF-β1, and BNP levels increased, their associated effect values also increased (P trend < 0.05). The interaction between HFEI score, TGF-β1, and BNP increased the risk of MACE. The interaction effect of HFEI score combined with BNP [HR = 3.92, 95% CI (2.81, 4.52), P < 0.001] on MACE prognosis was higher than that of TGF-β1 combined with HFEI score [HR = 3.70, 95% CI (2.63, 5.02), P < 0.001] and BNP combined with TGF-β1 [HR = 3.22, 95% CI (2.31, 4.48), P < 0.001]. A nomogram model combining HFEI score, TGF-β1, and BNP was constructed to predict the risk of MACE. The AUC before and after validation were 0.928 [95% CI (0.858, 0.998)] and 0.926 [95% CI (0.854, 0.997)], respectively. The average absolute error of the calibration curve was 0.012 in both cases, indicating that it can serve as a risk tool for predicting prognosis. Conclusion: The HFEI score, TGF-β1 level, and BNP level in DHF patients are positively correlated with NYHA functional classification and are risk factors for the progression and poor prognosis of DHF. With increasing HFEI score, TGF-β1 level, and BNP level, the association with prognosis becomes stronger, and there is an interaction between each pair. Early warning based on the nomogram model for these risk factors can help improve the prognosis of DHF patients.