Wang Chao-Hung, Cheng Mei-Ling, Liu Min-Hui, Kuo Li-Tang, Shiao Ming-Shi
Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan; Chang Gung University College of Medicine, Taoyuan 33302, Taiwan.
Healthy Aging Research Center, Chang Gung University, Tao-Yuan 33302, Taiwan; Metabolomics Core Laboratory, Chang Gung University, Tao-Yuan 33302, Taiwan; Department of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan.
J Cardiol. 2017 Jul;70(1):92-98. doi: 10.1016/j.jjcc.2016.10.005. Epub 2017 Mar 17.
Metabolic profiles have been shown to provide prognostic information in patients with heart failure (HF). Galectin-3 (Gal-3), indicating cardiac fibrosis, is a documented biomarker of prognosis in HF. It is unknown whether metabolic profiles provide prognostic value better than Gal-3.
This study analyzed 212 hospitalized HF patients, measuring metabolic score (composed by butyrylcarnitine, dimethylarginine/arginine ratio, spermidine, and total essential amino acids) and Gal-3. Endpoints were composite events (death/HF-related re-hospitalization). The median of metabolic scores and Gal-3 levels were 3.1 (1.3-5.2) and 17.8ng/mL (4.7-100ng/mL), respectively. Patients with higher metabolic scores had worse functional classes, higher atrial fibrillation incidences, levels of Gal-3 and B-type natriuretic peptide (BNP), but lower albumin levels and glomerular filtration rate. Correlations of metabolic score to Gal-3 and BNP were significant, but weak (r=0.34 and 0.41, respectively, both p<0.001). During a follow-up period of 4.2±1.4 years, there were 91 (42.9%) composite events. In univariate analysis, significant predictors of composite events were age, functional class, atrial fibrillation, levels of hemoglobin, log (Gal-3), log (BNP) and metabolic score. In multivariable analysis, adjusted for above variables, metabolic score remained a strong predictor of combined endpoints (hazard ratio=2.596, 95% confidence interval=1.649-4.087, p<0.001). C-statistics for the prediction of composite events significantly increased when metabolic score was incorporated into the model with established risk factors, BNP and Gal-3 [0.76 (0.70-0.83) vs. 0.66 (0.58-0.74), p=0.032].
Metabolic profile provides prognostic value for HF patients better than Gal-3.
代谢谱已被证明可为心力衰竭（HF）患者提供预后信息。半乳糖凝集素-3（Gal-3）提示心脏纤维化，是HF预后的一个已被证实的生物标志物。尚不清楚代谢谱是否比Gal-3具有更好的预后价值。
本研究分析了212例住院HF患者，测量了代谢评分（由丁酰肉碱、二甲基精氨酸/精氨酸比值、亚精胺和总必需氨基酸组成）和Gal-3。终点为复合事件（死亡/HF相关再住院）。代谢评分和Gal-3水平的中位数分别为3.1（1.3 - 5.2）和17.8ng/mL（4.7 - 100ng/mL）。代谢评分较高的患者功能分级较差，房颤发生率较高，Gal-3和B型利钠肽（BNP）水平较高，但白蛋白水平和肾小球滤过率较低。代谢评分与Gal-3和BNP的相关性显著，但较弱（r分别为0.34和0.41，均p<0.001）。在4.2±1.4年的随访期内，有91例（42.9%）复合事件。在单变量分析中，复合事件的显著预测因素为年龄、功能分级、房颤、血红蛋白水平、log（Gal-3）、log（BNP）和代谢评分。在多变量分析中，对上述变量进行校正后，代谢评分仍然是联合终点的有力预测因素（风险比 = 2.596，95%置信区间 = 1.649 - 4.087，p<0.001）。当将代谢评分纳入包含既定危险因素、BNP和Gal-3的模型时，复合事件预测的C统计量显著增加[0.76（0.70 - 0.83）对0.66（0.58 - 0.74），p = 0.032]。
代谢谱为HF患者提供的预后价值优于Gal-3。
