Hitsumoto Takashi
Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan. Email:
Cardiol Res. 2020 Aug;11(4):247-255. doi: 10.14740/cr1097. Epub 2020 Jun 3.
An autofluorescence (AF) reader can be used to diagnose skin AF non-invasively by measuring local accumulation of advanced glycation end-products. A number of studies have investigated the relationships between skin AF and cardiovascular disease. However, data regarding the usefulness of skin AF as a predictor of chronic heart failure remain limited. This prospective study aimed to elucidate the usefulness of skin AF as a predictor of first heart failure (HF) hospitalization in patients with HF with preserved ejection fraction (HFpEF).
A total of 412 outpatients with HFpEF with no history of HF hospitalization were enrolled. Patients were assigned to either the low (group L; skin AF ≤ 2.9 arbitrary units (AU); n = 303) or the high (group H; skin AF ≥ 3.0 AU; n = 109) group according to optimal skin AF cut-off levels determined using receiver operating characteristic curves. Clinical parameters and the usefulness of skin AF as a predictor of first HF hospitalization were evaluated.
The E/e' ratio as a marker of left ventricular diastolic function was significantly higher in group H patients than in group L patients at baseline (group H, 11.8 ± 3.8; group L, 10.6 ± 3.3; P = 0.002). During the 72.7-month follow-up period, 43 HF cases were hospitalized (group L, 15 cases; group H, 28 cases; P < 0.001, log-rank test). Multivariate Cox regression analyses revealed that group H exhibited a significantly higher risk of first HF hospitalization than did group L (hazard ratio, 2.26; 95% confidence interval, 1.21 - 3.52; P = 0.014).
The present study demonstrated that skin AF can predict the risk of first HF hospitalization in patients with HFpEF. Prospective studies, including intervention therapies, are required to validate our observations.
自体荧光（AF）阅读器可通过测量晚期糖基化终产物的局部积累来无创诊断皮肤AF。许多研究探讨了皮肤AF与心血管疾病之间的关系。然而，关于皮肤AF作为慢性心力衰竭预测指标的有用性的数据仍然有限。这项前瞻性研究旨在阐明皮肤AF作为射血分数保留的心力衰竭（HFpEF）患者首次心力衰竭（HF）住院预测指标的有用性。
共纳入412例无HF住院史的HFpEF门诊患者。根据使用受试者工作特征曲线确定的最佳皮肤AF截断水平，将患者分为低（L组；皮肤AF≤2.9任意单位（AU）；n = 303）或高（H组；皮肤AF≥3.0 AU；n = 109）组。评估临床参数以及皮肤AF作为首次HF住院预测指标的有用性。
作为左心室舒张功能标志物的E/e'比值在基线时H组患者显著高于L组患者（H组，11.8±3.8；L组，10.6±3.3；P = 0.002）。在72.7个月的随访期内，43例HF患者住院（L组15例；H组28例；P < 0.001，对数秩检验）。多变量Cox回归分析显示，H组首次HF住院的风险显著高于L组（风险比，2.26；95%置信区间，1.21 - 3.52；P = 0.014）。
本研究表明，皮肤AF可预测HFpEF患者首次HF住院的风险。需要进行包括干预治疗在内的前瞻性研究来验证我们的观察结果。
