Predictive value of serum heat shock protein 27 and its phosphorylation on the prognosis of patients with acute heart failure

Objective To explore the relationship between serum heat shock protein 27 (HSP27) and phosphorylated HSP27 (pHSP27) on the prognosis of patients with acute heart failure.

Methods A total of 178 patients who visited the Department of Cardiology of Fujian Provincial Hospital from December 2020 to June 2021 were included, including 40 patients in the control group and 138 patients in the acute heart failure group. The levels of serum HSP27 and pHSP27 were measured by enzyme-linked immunosorbent assay. The occurrence of recent major adverse cardiovascular events (MACE), including unstable angina, rehospitalization for heart failure, acute myocardial infarction, stroke, death, was observed during follow-up. The relationships of HSP27 and pHSP27 with MACE were analyzed.

Results The levels of serum HSP27 and pHSP27 in patients with acute heart failure were higher than those in the control group (P＜0.05). A total of 138 patients with acute heart failure were followed up for a median of 9 (P₂₅, P₇₅ 6, 12) months. A total of 30 patients developed MACE, including 10 cases of recurrent angina, 13 cases of rehospitalization for heart failure, 2 cases of stroke, and 5 deaths. The results of receiver operating characteristic (ROC) curve analysis showed that serum HSP27, pHSP27 and their combination could predict the occurrence of MACE in patients with acute heart failure, with the area under the curve (95%CI) being 0.634 (0.524–0.745), 0.656 (0.534–0.779), and 0.720 (0.611–0.829), respectively. After adjusted for gender, age, eosinophil count, platelet count, and N-terminal pro-brain natriuretic peptide (NT-proBNP), multivariate Cox regression analysis showed that high HSP27 (HR=1.009, 95%CI 1.003–1.016) and pHSP27 (HR=1.078, 1.037–1.139) were independent risk factors for MACE. Kaplan-Meier analysis showed that the time of MACE occurrence in the high-level HSP27 and pHSP27 groups was significantly earlier than that in the low-level HSP27 and pHSP27 groups, and the cumulative survival time was shorter in the low-level group (Log-rank, χ²=6.915, P=0.009; χ²=13.760, P＜0.001).

Conclusions Serum HSP27 and pHSP27 levels are significantly increased in patients with acute heart failure. High levels of HSP27 and its phosphorylation are closely related to the occurrence of poor prognosis.