Yoshihisa Akiomi, Watanabe Shunsuke, Yokokawa Tetsuro, Misaka Tomofumi, Sato Takamasa, Suzuki Satoshi, Oikawa Masayoshi, Kobayashi Atsushi, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
ESC Heart Fail. 2017 Aug;4(3):360-364. doi: 10.1002/ehf2.12176. Epub 2017 Jun 26.
The failing heart is accompanied by disturbed energy metabolism with mitochondrial dysfunction. Carnitine transports fatty acids into mitochondria for β-oxidation. Decreased myocardial carnitine levels accompanied by increased plasma carnitine levels in heart failure (HF) have been reported. The plasma acylcarnitine to free carnitine ratio (AC/FC) is recognized as a marker of carnitine deficiency. We aimed to investigate the impact of the AC/FC on HF prognosis, taking into consideration differences between HF patients with preserved ejection fraction (HFpEF) and those with reduced ejection fraction (HFrEF).
Consecutive 168 HF patients were divided into three groups based on their AC/FC: first to third tertiles (n = 56, respectively). We followed up all patients for cardiac events including cardiac death and/or worsening HF. During the follow-up period (1004 days), there were 23 cardiac deaths and 28 worsening HF. In the Kaplan-Meier analysis, the cardiac event rate of the third group was highest among the three groups (P = 0.022). In the Cox proportional hazard analysis, AC/FC was a predictor of cardiac events (P = 0.007). When HFpEF (n = 79) and HFrEF (n = 89) were analysed separately, the cardiac event rate of the third group was highest with regard to HFpEF (P = 0.008), but not HFrEF (P = 0.321). In the Cox proportional hazard analysis, AC/FC was a predictor of cardiac events with regard to HFpEF (P = 0.031), but not HFrEF (P = 0.095). Therefore, the impact of the AC/FC on cardiac events was different between HFpEF and HFrEF (P = 0.042 for interaction).
The AC/FC can identify high risk HF patients, especially in HFpEF.
衰竭心脏伴有能量代谢紊乱及线粒体功能障碍。肉碱将脂肪酸转运至线粒体进行β氧化。据报道，心力衰竭（HF）患者心肌肉碱水平降低，同时血浆肉碱水平升高。血浆酰基肉碱与游离肉碱比值（AC/FC）被认为是肉碱缺乏的标志物。我们旨在研究AC/FC对HF预后的影响，同时考虑射血分数保留的HF患者（HFpEF）和射血分数降低的HF患者（HFrEF）之间的差异。
连续纳入168例HF患者，根据其AC/FC分为三组：第一至第三三分位数（每组n = 56）。我们对所有患者进行随访，观察包括心源性死亡和/或HF恶化在内的心脏事件。在随访期（1004天）内，发生23例心源性死亡和28例HF恶化。在Kaplan-Meier分析中，第三组的心脏事件发生率在三组中最高（P = 0.022）。在Cox比例风险分析中，AC/FC是心脏事件的预测因子（P = 0.007）。当分别分析HFpEF（n = 79）和HFrEF（n = 89）时，第三组的心脏事件发生率在HFpEF方面最高（P = 0.008），而在HFrEF方面并非如此（P = 0.321）。在Cox比例风险分析中，AC/FC是HFpEF心脏事件的预测因子（P = 0.031），而不是HFrEF心脏事件的预测因子（P = 0.095）。因此，AC/FC对心脏事件的影响在HFpEF和HFrEF之间存在差异（交互作用P = 0.042）。
AC/FC可识别高风险HF患者，尤其是HFpEF患者。
