Correlation Circulating Adiponectin with NT-proBNP
in patients with Chronic Heart Failure


18 Sep 2020, 20:45 Harry Ridwan Dibaca : 338


Correlation Circulating Adiponectin with NT-proBNP in patients with

Chronic Heart Failure

Badai Tiksnadi, Augustine Purnomowati, Erwan Martanto, Toni M.Aprami

Department of Cardiology and Vascular Medicine, Padjadjaran University, Bandung, Indonesia



Background   

Heart failure’s mortality rate still remains high, and the patients still have a poor quality of life.1,2 There are many parameters to predict prognosis of patient with chronic heart failure (CHF). NT-proBNP has previously studied and has widely accepted for predict poor outcom.3 Adiponectin is a recently discovered adipocyte-specific cytokine, which had been proposed to have insulin sensitizing, anti-inflammatory and antiatherogenic properties.4,5  Its role in patients with heart failure is still inconsistent.6-9 The aim of this study was to determine correlation of circulating adiponectin with NT-proBNP in CHF patients.

Methods 

This was a clinical epidemiology, cross sectional designed, and observasional study. Serum and clinical data were obtained from patients with CHF who met inclusion criteria, consecutively from March to April 2011. The inclusions criteria was heart failure determined by abnormality of echocardiography. The etiology of heart failure were restricted to coronary artery disease (CAD), hypertensive heart disease (HHD), dilated cardiomiopathy (DCM) or combination. The association between serum adiponectin and NT-proBNP was analyzed by Pearson correlation test. The differences in adiponectin level within NYHA Class were analyzed by One-way ANOVA test.

Results  

There were 99 CHF patients  participated in this study. The baseline characteristics were listed in table 1.

Table 1. Baseline clinical characteristics.

Age (mean, SD) in years

58.74 (9.9)

Men (n, %)

49 (48)

LVEF (mean, SD) in %

46.91 (16.3)

Systolic dysfunctions (n, %)

61 (61.8)

Diastolic dysfunctions (n, %)

BMI (mean, SD) in kg/m2

38 (38.2)

25.11 (4.19)

 

Forty three point four percents patient presented CHF NYHA Class II, 24.2% NYHA Class IV, 21.4% NYHA Class III and 11.1% NYHA Class I (as listed in Figure 1). The etiology of heart failure were 35.4% caused by HHD, 31.3% by combination CAD and HHD, 29.3% by CAD and only 4.0% caused by DCM (as listed in Figure 2).

 

Figure 1. Clinically category of CHF by NYHA class

 Figure 2. Etiology of CHF by echocardiograpy

 In patients with CHF the adiponectin concentration correlate significantly with NT-proBNP level with correlation coefficient (r)  0.71 and p value 0.0001.  The figure belows show the data distribution of adiponectin and NT-proBNP in patients with CHF (figure 3).

 Figure 3. Data distribution of adiponectin and NT-proBNP level in CHF patients

In the subanalysis of this study, there were significant differences in adiponectin level between NYHA class III (p=0.004) and class IV (p=0.037) compare to NYHA class I, and between NYHA class III and IV (both p=0.0001) if compared to NYHA class II (Figure 4). Patients with NYHA Class I (7.27 + 3.53) and II (8.38 + 4.85) had significantly lower adiponectin concentrations than patients NYHA Class III (16.59 + 7.82) and  IV (10.55 + 6.59). There were no significant differences in adiponectin level between NYHA class I and II (p=1.000) and between NYHA class III and IV (p=1.000).

Figure 4. Data distribution of adiponectin level within NYHA Class in CHF patients


Interestingly, serum adiponectin concentrations were found to significantly correlated with serum NT-proBNP, which has widely known as an indicator for severity of the diseases and a good predictor for poor outcome.  Our results were consistent with recent studies6 that found a correlation with r = 0.45 (p < 0.0001).In this study, there were no significant differences between BMI within NYHA Class (table 2) with p = 0.346 between NYHA Class II and I, p = 0.140 between NYHA Class III compared to Class I and p = 0.530 between NYHA Class IV and Class I.

 

Table 2. Level BMI within NYHA Class of CHF and differences within groups

 

NYHA Class I

NYHA Class II

NYHA Class III

NYHA Class IV

Total (Percentage)

11

20

41

18

BMI level (mean, SD)

25.16 + 2.98

26.39 + 4.01

23.25 + 3.52

24.25 + 5.14

Compare means (Independent t-test)

compared with DC fc I

 

p = 0.346

p = 0.140

p = 0.530

 

Discussion

Our data then suggested classical risk predictors such as low adiponectin levels lose its protective value during disease progression. There were several explanation for this ‘paradox’. The first,  natriuretic peptides itselves could directly increase adiponectin production by enhancing the expression of adiponectin mRNA and its secretion.10 The second one was “adiponectin resistance” hypothesis,11 that showed a decrease mRNA  and protein expression of the adiponectin receptor (AdipoR1) in the left ventricle of infarcted hearts,12 and “downregulation” of AdipoR1 in skeletal muscle of CHF patients.13 The third one was that the production of adiponectin by adiposities parallels the activation of neurohormonal and inflammatory axes.6

Patients with severe form of CHF had higher adiponectin concentrations, similar with George et al study.6  In this study, the insignificance differences between adiponectin levels in NYHA Class I and II, and between NYHA Class III and IV, perhaps because of the assessment that only based on subjective and clinical situation.

In this study, there were no significant differences between BMI within NYHA Class of CHF, so that the higher adiponectin level in CHF patients with NYHA Class III and IV compare to NYHA Class I and II, was not influenced by BMI.

 

Conclussion

Adiponectin were significantly correlated with NT-proBNP in patients with chronic heart failure. There was significant difference in adiponectin level between NYHA Class I-II with Class III-IV. Further studies in CHF patients are needed especially to determine the direct enhanced expression of adiponectin caused by neurohormonal and inflammatory reactions, and to study the adiponectin receptor in failing heart regardless of the cause.



Pengirim : Badai Tiksnadi


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